Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: a case report

L4-L5 Facet Dislocation Treated in a Delayed Fashion with Excellent Early Clinical Results

Introduction

Introduction: Lumbar facet fracture-dislocations are rare injuries that are generated from a significant trauma. Literature regarding these injuries is limited to case reports, and there are even more limited reports concerning whether the delay of operative intervention in neurologically intact patients can achieve good clinical results if concomitant injuries and/or medical issues preclude urgent operative intervention. There has been no consensus on which operative techniques are effective in achieving an anatomic reduction of these injuries.

Objectives

A case report of an L4-L5 facet fracture-dislocation with delayed operative intervention and previously not reported adjunctive reduction technique is presented with an excellent clinical outcome result being achieved.

Case Report

A 38-year-old female who presented with an L4-L5 facet fracture-dislocation without neurological deficit after an unknown mechanism of injury. Due to concerns for elevated risk of intra and perioperative complications from general anesthesia secondary to recent drug use, the patient ultimately underwent open reduction and L4-L5 posterior instrumentation and fusion, with a resection of the superior aspect of the L5 pedicle being performed to help achieve reduction. The patient did not report any significant lower back pain and remained motor intact at 6-month post-operative, with the only neurological symptom during her post-operative course being hypesthesias in the right L5 dermatome at 6-week post-operative.

Conclusion

Excellent clinical results can be achieved with delayed open reduction and posterior stabilization in patients that sustain lumbar facet-fracture dislocations. The precise timing for operative management for patients who sustain these injuries is unknown, but medical stability should be considered before proceeding with an operative intervention in neurological intact patients. Partial resection of the pedicle is a safe and effective reduction technique in certain fracture-dislocation patterns.

Acute Translation Fracture of the Lumbar Spine With Increased Motoric Outcomes: A Case Report

Translation fracture of the lumbar spine is a rare but serious condition that necessitates prompt medical attention. This injury can cause nerve damage, spinal cord compression, and other complications that can affect motor function. The motoric outcomes of this fracture type depend on a variety of factors, including the severity and location of the fracture, the age and general health of the patient, and the timeliness and effectiveness of treatment. Accurate diagnosis and treatment of these injuries is important to prevent further neurological damage and improve motoric outcomes. Here we present the case of a male patient with a translation fracture at the L1-L2 level with AO spine type C who underwent immediate realignment and posterior stabilization, and subsequently participated in an early rehabilitation program, resulting in improved neurologic function. Thoracolumbar fracture with lateral dislocation is very rare and significant experience is needed to determine which management strategy can ensure the best outcome.

Traumatic Lumbar Spondylolisthesis: A Systematic Review and Case Series

STUDY DESIGN

Systematic review and case series.

OBJECTIVES

Any acute injury to the posterior elements of the lumbar spine resulting in listhesis is considered a traumatic spondylolisthesis. This rare injury caused by high-energy trauma is variably described in the literature as fracture-dislocation, where only case reports and series have been published. Our objectives were to propose evidence-based treatment recommendations and a new classification system for this injury.

METHODS

A systematic review of literature from PubMed, EMBASE, and Cochrane without time frame limitations was performed, which included 77 level IV and V articles and 9 patients as case series in the analysis.

RESULTS

A total of 125 cases were reviewed with mean age of 30.5 years. Half of the cases resulted from a vehicular accident. Back pain presented in 82%, while 50% had neurologic deficits. Operative treatment was performed in 93.6% (posterior decompression [PD] = 4%; posterior spinal fusion [PSF] = 43.2%; interbody fusion [IB] = 46.4%) with overall fusion rates of 74%. Binomial regression analysis for achieving solid fusion showed a 28.6× higher odds for IB compared to PSF (P = .008, r ² = 0.633). Subanalysis of cases with disc injuries revealed higher fusion outcomes for IB (87%) compared to PSF (46%; P = .006), while there were no significant differences for patients without disc injury. Pain and neurological symptoms improved significantly on final follow-up (P < .001). Overall complication rate was 22%.

CONCLUSION

Operative management with reduction, decompression for neurologic deficits, instrumentation, and fusion is recommended for traumatic spondylolisthesis. Interbody fusion is recommended to achieve better fusion outcomes especially with preoperatively identified disc lesions.