Traumatic lumbosacral dislocation: report of two cases

Abstract

Study design: A retrospective study of 2 patients with traumatic lumbosacral dislocation.

Objectives: To discuss the difficulty in making diagnosis and the effect of surgical treatment.

Summary of background data: Traumatic lumbosacral dislocation is an uncommon injury, which creates diagnostic difficulty and is typically managed by open reduction internal fixation of the lumbosacral spine.

Methods: Medical notes and imaging of the 2 patients were reviewed.

Results: Both patients were engaged in high-energy accidents and had concomitant injuries. Patient 1 was initially misdiagnosed as having L5 lytic spondylolisthesis and was treated with a lumbar corset. She developed progressive low back and left leg pain. Eleven months after the accident, a bilateral lumbosacral dislocation with right S1 superior facet fracture, disc rupture, posterior soft tissue disruption, and a resultant Grade 4 L5-S1 traumatic spondylolisthesis was identified. She underwent open reduction, followed by a staged anteroposterior spinal arthrodesis using instrumentation with excellent results. Patient 2 sustained a unilateral L5-S1 facet dislocation without neurologic deficit, which reduced spontaneously. The evaluation demonstrated a grossly disturbed posterior ligamentous complex adjacent to the lumbosacral articulation. A combined anteroposterior spinal fusion with instrumentation was performed with favorable outcome.

Conclusion: Meticulous clinical examination and careful imaging assessment, including CT and MRI, assist an early diagnosis in cases of lumbosacral dislocation. Open reduction and circumferential bony fusion restore segmental stability and painless function.