Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Traumatic lumbosacral dislocation is a rare, high-energy mechanism injury characterized by displacement of the fifth lumbar vertebra in relation to the sacrum. Due to the violent trauma typically associated with this lesion, there are often severe, coexisting injuries. High-quality radiographic studies, in addition to appropriate utilization of CT scan and MRI, are essential for proper evaluation and diagnosis. Although reports in the literature include nonoperative and operative management, most authors advocate for surgical treatment with open reduction and decompression with instrumentation and fusion. Despite advances in early diagnosis and management, this injury type is associated with significant morbidity and mortality, and long-term patient outcomes remain unclear.

Luxación Facetaria Unilateral Lumbosacra Postraumática

<p><strong>RESUMEN</strong></p><p>En la bibliografía se han reportado alrededor de medio centenar de casos de luxaciones lumbosacras; la mayor parte se tratan de luxaciones facetarias bilaterales. Presentamos el caso de una paciente mujer de 42 años con luxación facetaria unilateral lumbosacra de un mes de evolución tras accidente de tráfico. Se realiza artrodesis circunferencial L5-S1 instrumentada con caja intersomática y tornillos pediculares L5-S1.</p><p> </p><p>La luxación lumbosacra es una lesión poco habitual que se produce gracias a la combinación de un mecanismo de alta energía con factores anatómicos predisponentes. Recientes publicaciones defienden la reducción quirúrgica y estabilización con instrumentación como tratamiento estándar.</p><p><strong>Palabras clave</strong></p><p>Luxación; unión lumbosacra; artrodesis</p><p> </p><p> </p><p><strong>ABSTRACT</strong></p><p>In the literature have been reported around fifty cases of lumbosacral dislocations; treated most bilateral facet dislocations. We report the case of a female 42 year old with unilateral lumbosacral facet dislocation of one month duration after accident. Circumferential instrumented fusion L5-S1 with interbody cage and pedicle screws L5-S1 was performed.</p><p> </p><p>The lumbosacral dislocation is a rare injury that occurs due to the combination of a high-energy mechanism predisposing anatomical factors. Recent publications advocate the surgical reduction and stabilization with instrumentation as standard treatment.</p><p><strong>Key Words</strong></p><p>Dislocation; Lumbosacral junction; Arthrodesis.</p>

Unilateral Lumbosacral Dislocation: Case Report and a Comprehensive Review

Lumbosacral fracture-dislocation is a rare occurrence. There are more than 73 cases reported in the English literature. We report on the imaging findings and surgical treatment in a patient suffered of unilateral traumatic L5-S1 dislocation associated with severe disruption of the posterior ligamentous complex. The patient underwent open reduction and stabilization of L4-S1 vertebrae with posterior instrumentation system. Open reduction and internal fixation was mandatory as post-traumatic ligamentous insufficiency would lead to abnormal motion. Operative treatment managed to produce a solid arthrodesis and restore stability of the lumbosacral junction. Follow-up revealed excellent results. This study reports a rare injury of the lumbosacral junction, and the literature concerning this unusual condition is extensively reviewed.

Traumatic Lumbosacral Dislocation Treated with Posterior Lumbar Interbody Fusion Using Intersomatic Cages

A 35-year-old man was struck by a car on his right side and presented with paraparesis of both lower extremities. Radiographic examination revealed multiple transverse process fractures and anterior displacement of L5 on S1. Computed tomography revealed a bilateral anterior facet dislocation of the fifth lumbar vertebra on the sacrum. MRI showed rupture of the posterior ligamentous complex. A posterior lumbar interbody fusion using two intersomatic cages and pedicle screw instrumentation and posterior fusion were performed. Although no major disc lesion was found at the level of L5-S1 on preoperative MRI, a severely collapsed L5-S1 disc was found intraoperatively. Two years after surgery, the patient was asymptomatic with normal neurological findings, and has resumed normal activity. We believe that lumbosacral dislocation can be considered a three-column injury with an L5-S1 disc lesion, and, therefore, requires a solid circumferential segmental arthrodesis to improve fusion rate.

U-SHAPED SACRAL FRACTURE AND LUMBOSACRAL DISLOCATION AS A RESULT OF A SHOTGUN INJURY

OBJECTIVE Gunshot wounds to the spine and/or sacrum rarely cause spinal instability. Our goal is to report the first case of a U-shaped sacral fracture and lumbosacral dislocation caused by a gunshot injury to the spine. CLINICAL PRESENTATION A 37-year-old man sustained a close-range shotgun wound to the abdomen. The blast partially destroyed the L4 and L5 vertebral bodies and fractured the S1 and S2 segments of the spine, resulting in severe neurological deficits with lumbosacral and spinopelvic instability. INTERVENTION Debridement of devitalized tissues, proper antibiotic coverage, decompression of the cauda equina, and lumbopelvic fixation. CONCLUSION Close-range shotgun injuries result in massive destruction of tissues. As opposed to civilian injuries, a different approach must be taken to prevent infectious complications. A bilateral lumbopelvic fixation using long iliac screws effectively restored lumbosacral pelvic stability.