Traumatic L1–L2 Dislocation Without Fracture in a 6-Year-Old Girl

Yazıcı, Muharrem; Alanay, Ahmet; Mc, Aksoy; Acaroğlu, Emre; Surat, Adil

doi:10.1097/00007632-199907150-00015

Cited by 15 publications

(29 citation statements)

References 15 publications

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“…Its reported incidence in large series varies between 2 [4] and 10% [2] of all cases of spinal injury and is frequently localized in the cervical vertebrae [1,2,4] . In the relevant literature we found only 1 case of vertebral lumbar dislocation without fracture in the pediatric population [10] . Patients with subluxation were reported to present a higher incidence of neurologic injury than did patients with fracture alone [2,5,10] .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Reduction of a Traumatic L2-L3 Subluxation without Fracture in a 14-Year-Old Boy

Mouhsine¹,

Theumann²,

Wettstein³

et al. 2006

Med Princ Pract

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Objective: To report a rare case of lumbar vertebral subluxation associated with spontaneous reduction in an adolescent treated conservatively. Clinical Presentation and Intervention: A 14-year-old male victim of a snowboard accident, which caused a lumbar spinal injury, was referred to the emergency room with significant lumbar pain. Neurologic examination was normal. Radiographic assessment at admission showed a unilateral left lateral subluxation of the L2-L3 vertebrae without associated fractures. These findings were confirmed by CT scan and a surgical management was decided. The preoperative MRI performed 24 h after the accident, however, revealed the spontaneous reduction of the subluxation, and an associated tear of the quadratus lumborum and the psoas muscles on the right side at the level of L2, L3 and L4. Following these findings conservative treatment with a plaster brace for 2 months was carried out. The brace was removed after 2 months. The patient had no pain and the range of motion of his lumbar spine was normal. Three months after injury, sports activities were resumed. At follow-up of 24 months, the patient was free of pain and radiographs showed a right positional bending without rotational or translation anomaly. Conclusion: To date, this is the first case of subluxation without fracture in a child, presenting without neurological deficit and where spontaneous reduction occurred. In this case, conservative treatment was effective and the outcome at 2-year follow-up was excellent.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Reduction of a Traumatic L2-L3 Subluxation without Fracture in a 14-Year-Old Boy

Mouhsine¹,

Theumann²,

Wettstein³

et al. 2006

Med Princ Pract

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“…Less than 3% involve fracture/dislocation injuries (7) and fracture with severe dislocation is even rarer, with only a few reported cases, most of which are lumbosacral (L5/S1). Thoracolumbar involvement is extremely rare (38,40,43).…”

Section: Discussionmentioning

confidence: 99%

Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series

Xiong

Li²,

Zhang³

et al. 2012

Turkish Neurosurgery

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AIm: This study reports a technique for treating severe thoracolumbar fractures with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach. mAterIAl and methOds:The cases of 11 patients with severe traumatic thoracolumbar fractures/dislocations that were managed with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach were included. Data on age, sex, mechanism of injury, associated trauma, neurological status, surgical technique, and clinical outcome were reviewed retrospectively. results: Of the 11 patients, two presented with primarily coronal displacement and nine with sagittal displacement. Coronal displacement was corrected from 19% preoperatively to 4.0% at the last follow-up evaluation. Sagittal displacement was reduced from 73.0% preoperatively to 3.0% at the last follow-up evaluation. After a mean follow-up period of 20.7 (range 16-30) months, no patient complained of local pain and no significant loss of correction or hardware failure was observed.COnClusIOn: Our experience proves that the single-stage posterior approach is safe and biomechanically reliable for treating severe thoracolumbar fractures/dislocations. Therefore, the presented technique is an alternative approach for this rare injury.KeywOrds: Thoracolumbar fracture, Severe dislocation, Single-stage, Posterior approach ÖZ AmAÇ: Bu çalışma, tamamen posterior bir yaklaşımla tek evreli dekompresyon, redüksiyon, rekonstrüksiyon ve stabilizasyon ile şiddetli torakolumber kırıkları tedavi etmek için bir tekniği bildirmektedir. yÖntem ve GereÇler: Tamamen posterior yaklaşımla tek evreli dekompresyon, redüksiyon, rekonstrüksiyon ve stabilizasyonla tedavi edilen şiddetli travmatik torakolumber kırık/dislokasyonu olan 11 vaka dahil edilmiştir. Yaş, cinsiyet, yaralanma mekanizması, ilgili travma, nörolojik durum, cerrahi teknik ve klinik sonuçlarla ilgili veriler retrospektif olarak gözden geçirilmiştir.BulGulAr: 11 hasta içinde ikisi primer koronal displasman ve dokuzu sajital displasmanla gelmiştir. Sajital displasman preoperatif olarak %19'dan son takip değerlendirmesinde %4,0'a düzeltilmiştir. Sajital displasman preoperatif olarak %73,0'dan son takip değerlendirmesinde %3,0'a düzeltilmiştir. Ortalama 20,7 (aralık 16-30) aylık takip süresiyle hiçbir hasta yerel ağrıdan yakınmamış ve düzeltmede önemli bir kayıp veya donanımla ilgili başarısızlık gözlenmemiştir. sOnuÇ: Deneyimimiz tek evreli posterior yaklaşımın şiddetli torakolumber kırıklar/dislokasyonlar tedavisinde güvenli ve biyomekanik olarak uyumlu olduğunu göstermiştir. Bu nedenle sunulan teknik bu nadir yaralanma için alternatif bir yaklaşımdır.

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“…Although the surgical treatment for pediatric lumbar injuries is open reduction and internal fixation, the optimal materials for fixation and the extent of fusion remain controversial. Yazici et al [22] reported a case of L1-L2 dislocation in a 6-year-old girl treated with 4-level instrumentation and 1-level fusion using a modified Luque frame with sublaminar wires, in whom magnetic resonance imaging after removal of the implants revealed disc narrowing at multiple levels within the instrument’s limits. The feasibility of short-range stabilization due to greater stability of pedicle screw fixation, resulting in minimal reduction in spinal mobility, is an advantage of pedicle screw fixation.…”

Section: Discussionmentioning

confidence: 99%

L2-L3 Flexion-Distraction Injury Treated by Posterior Fusion Using Ultra-High Molecular Weight Polyethylene Tape in a 7-Year-Old Boy

Tofuku¹,

Koga²,

Kawabata³

et al. 2009

Pediatr Neurosurg

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A 7-year-old boy was sitting in the back seat of a car wearing a lap seatbelt when the car was involved in a head-on collision with another vehicle. Radiographs revealed mild scoliosis, anterior column compression of L3 and enlargement of both the intervertebral foramen and interspinous distance between L2 and L3. Computed tomography revealed bilateral L2-L3 facet joint disruption with fracture of the L2 spinous process. Magnetic resonance imaging revealed rupture of the posterior ligamentous complex. An open reduction and posterior fusion with autologous bone graft using 5-mm-wide ultra-high molecular weight polyethylene tape sublaminar wiring was performed. Three months after surgery, bony fusion of L2-L3 was observed. At 6 months after surgery, the patient was asymptomatic and had resumed previous activities.

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Traumatic L1–L2 Dislocation Without Fracture in a 6-Year-Old Girl

Abstract: To date, this is the first case of dislocation of the thoracolumbar spine in children. It is further notable because the neurologic deficit was incomplete, although there were striking radiologic abnormalities.

Cited by 15 publications

References 15 publications

Spontaneous Reduction of a Traumatic L2-L3 Subluxation without Fracture in a 14-Year-Old Boy

Spontaneous Reduction of a Traumatic L2-L3 Subluxation without Fracture in a 14-Year-Old Boy

Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series

L2-L3 Flexion-Distraction Injury Treated by Posterior Fusion Using Ultra-High Molecular Weight Polyethylene Tape in a 7-Year-Old Boy

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