Traumatic noncontiguous double fracture-dislocation of the lumbosacral spine

Abstract

Background context: To our knowledge, the presence of noncontiguous fracture-dislocation of the lumbosacral spine occurring at two levels has not been reported. The etiology, evaluation, and treatment of the unusual injury is presented.

Purpose: To notify spinal traumatologists about the possibility of this unusual injury.

Study design: A case report of an unusual noncontiguous double fracture-dislocation of the lumbosacral spine.

Methods: A 26-year-old man was involved in a motor vehicle accident where his car fell over a bridge and plummeted approximately 300 feet before hitting the ground. The patient was transported to a major medical center where he was found to be conscious, and amazingly, his only major injury was fracture-dislocations of L2-L3 and L5-S1. His preoperative neurologic status showed a partial paraparesis to all motor groups of the lower extremities bilaterally.

Results: The patient underwent a posterior reduction, instrumentation, and fusion from L1 to S1 with autogenous bone graft and segmental pedicle screw instrumentation. One week postoperatively, he underwent an anterior spinal fusion of L5/S1. Postoperatively, his neurologic status improved allowing him to be ambulatory, with a normal lumbosacral alignment being well-maintained.

Conclusions: Noncontiguous double fracture-dislocation of the lumbosacral spine is an unusual injury, which results from a very high-energy trauma. Prompt recognition of the injuries, reduction of the fracture-dislocations, and posterior stabilization is recommended for neural decompression, spinal alignment, and long-term stabilization.