Unilateral Lumbosacral Facet Fracture-Dislocation

Carl, A.; Blair, Benjamin

doi:10.1097/00007632-199102000-00023

Cited by 30 publications

(17 citation statements)

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“…12,14,20,22,23,32 In a unilateral lumbosacral facet-dislocation (type 1), posterior instrumentation and fusion alone may be sufficient. 5,6,16,18 Since the L5/S1 disc is disrupted, interbody fusion is required in types 2 and 3. Taking into consideration the trauma of major surgical invasion, posterior lumbar interbody fusion via a single approach may be preferable to the combined procedure.…”

Section: Discussionmentioning

confidence: 99%

Fracture-dislocation of the fifth lumbar vertebra

Aihara¹,

Takahashi

Yamagata

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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We have studied fracture-dislocation of the fifth lumbar vertebra in seven patients and reviewed 50 previously reported cases. Based on this information, we have classified the injury into five types: type 1, unilateral lumbosacral facet-dislocation with or without facet fracture; type 2, bilateral lumbosacral facet-dislocation with or without facet fracture; type 3, unilateral lumbosacral facet-dislocation and contralateral lumbosacral facet fracture; type 4, dislocation of the body of L5 with bilateral fracture of the pars interarticularis; and type 5, dislocation of the body of L5 with fracture of the body and/or pedicle, with or without injury of the lamina and/or facet.Conservative treatment of fracture-dislocation of L5 is generally not effective because the lesion is fundamentally unstable. Planning of the operation should be made on the basis of the various types of injury. [Br] 1998;80-B:840-5. J Bone Joint Surg Received 18 December 1997; Accepted after revision 2 April 1998Fracture-dislocation of the fifth lumbar vertebra is relatively rare; its treatment presents challenging problems. About 70 cases have been reported in the literature, but there is as yet no rational classification of the disorder. Our aim is to describe the types of injury, the operative methods used, and the outcome of seven new cases and 50 published cases for which there is sufficient documentation.1-32 Based on this analysis, a new classification of the disorder is proposed. Patients and MethodsThis series. Between 1976 and 1997 seven men had surgery for fracture-dislocation of the fifth lumbar vertebra. Their mean age at operation was 22.6 years (16 to 28) with a mean period of follow-up of four years (2 to 6.75). The cause of injury was high-energy trauma in every case.There was a unilateral lumbosacral facet-dislocation and contralateral lumbosacral facet fracture in three (cases 2, 3, 7), dislocation of the body of L5 with fracture of the vertebral body, lamina, and the L4/L5 facet in two (cases 4 and 5), bilateral lumbosacral facet-dislocation in one (case 1), and acute spondylolytic spondylolisthesis in one (case 6).Before treatment, all patients complained of severe low back pain. Six had radicular symptoms and two bowel and bladder dysfunction (Table I). Six of the patients were referred to our hospital after long-term conservative treatment over a mean of seven months (5 weeks to 20 months).Three patients had posterior decompression and posterolateral fusion using pedicle screws, followed by anterior interbody fusion at the L5/S1 level (cases 1, 3 and 7). One had posterior decompression and posterolateral fusion using pedicle screws from L3 to S1, followed by anterior interbody fusion at the L4/L5 level (case 4). One patient was treated by posterior decompression and posterolateral fusion using pedicle screws, without anterior interbody fusion (case 2). A posterior wire reduction device 33 was used to reduce the subluxation followed by anterior interbody fusion in our two earlier patients (cases 5, 6), in one without p...

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Section: Discussionmentioning

confidence: 99%

Fracture-dislocation of the fifth lumbar vertebra

Aihara¹,

Takahashi

Yamagata

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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“…The time interval between trauma and surgery may make reduction difficult [3,4,7]; in the cases that came to our observation this never happened. In our opinion the ease of reduction also depends on the method used during surgery, which includes the application of a temporary distraction system placed strut-like between the wing of the sacrum and the posterior arch of the first or second lumbar vertebra -not unlike what occurs for intraoperative reduction of severe spondylolisthesis [8,12,19].…”

Section: Strategy Of Treatmentmentioning

confidence: 61%

Traumatic L5-S1 spondylolisthesis: report of three cases and a review of the literature

Fabris

Costantini

Nena

et al. 1999

European Spine Journal

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IntroductionTraumatic lumbosacral spondylolisthesis is a very uncommon lesion. The literature testifies to this rareness, reporting only 22 cases over the last 50 years [1, 2, 4, 5, 7, 9-11, 13-15, 21, 22]. These include seven cases of pure bilateral dislocation [1,4,5,7,11,15,22]. The specific features of the lesion, as well as the different possible radiographic and clinical findings that characterize it, have encouraged many researchers to attempt to propose possible interpretations of the kinematics of the lesion. PathomechanicsThe mechanics of the lesion, on the basis of its rareness and its association with monolateral fractures of the lumbar transverse apophyses, which occur in a very high percentage of cases, has been the subject of numerous studies, the conclusions of which often appear to disagree.Hyperextension has been pointed to as an efficient traumatic vector [23]; other authors appear to disagree, believing that the main mechanism responsible for the lesion is constituted by the association between hyperflexion, compression and rotation [4,11,21,24], or by the action of the direct traumatic vectors [1,17].In the cases that came to our observation, an accurate history of each patient allowed us to generally reconstruct the dynamics of the trauma. The patient with a "pure" dislocation had undergone sudden hyperflexion of the lumbosacral spine, with his thighs flexed on the pelvis. This had been provoked by doing a somersault in the air and landing on his bottom. In the patient with fracture-dislocation, the main traumatic mechanism had been violent and direct posterior trauma in the lumbar spine (the patient had been thrown from a motorcycle ending up against a pole). This mechanism, in clear contrast to what has been affirmed by Roaf [20], appears to be similar to that described by Beguiristain et al. [1], and it may be likened to an actual lesion caused by the application of shear traumatic vectors. AbstractThe literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages.Key words Lumbosacral spine · Fracture-dislocations · Traumatic L5-S1 spondylolisthesis · Surgical treatment ORIGINAL ARTICLE Eur Spine J (1999) 8 : 290-295

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“…Because of severe spinal and ligamentous damage, traumatic fracture–dislocation of the lumbosacral spine is rendered highly unstable [12]. Because it is a three-column injury, open reduction and internal fixation should be recommended [3, 5, 7–9, 12–14]. This injury results in multiple organ injury, and treatment of vital organ lesions undoubtedly remains a priority.…”

Section: Discussionmentioning

confidence: 99%