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Case Reports
. 2011 Mar 3:2:26.
doi: 10.4103/2152-7806.77278.

Management of distraction injury of the lumbosacral junction with unilateral perched facet

Clemens M Schirmer  1 , Erica F Bisson
Affiliations
Case Reports

Management of distraction injury of the lumbosacral junction with unilateral perched facet

Clemens M Schirmer et al. Surg Neurol Int. .

Abstract

Background: Traumatic unilateral facet dislocation without fracture is an uncommon injury of the lumbosacral junction. We describe a case of a unilateral perched L5-S1 facet causing axial back pain and radiculopathy provoked by motion.

Case description: The patient underwent reduction with complete facetectomy followed by internal fixation at L5-S1, facilitating decompression of the S1 nerve root. Postoperatively, the patient reported improvement in her pain.

Conclusions: This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements. Despite its rarity, when identified, this injury can be characterized using the new TLICS system for thoracolumbar fractures and should be managed accordingly.

Keywords: Facet dislocation; operative management; trauma.

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Figures

Figure 1
Figure 1
Plain lateral radiograph of the lumbar spine, demonstrating subtle widening of one of the L5–S1 neuroforamina
Figure 2
Figure 2
Computed tomography of the lumbar spine. Sagittal reconstruction through the perched right L5–S1 facet joint
Figure 3
Figure 3
Anterior (a) and right lateral (b) views of the three-dimensional reconstruction of the computed tomography scan of the lumbar spine, demonstrating the unilateral perched facet joint and asymmetric widening of the L5–S1 disc space
Figure 4
Figure 4
Coronal inversion recovery (STIR) weighted image showing edema and asymmetric widening of the L5–S1 disc space
Figure 5
Figure 5
Sagittal reconstruction of the postoperative computed tomography showing the extent of resection of the articular processes and the transpedicular posterior segmental fixation on the right side. A portion of the polyetheretherketone (PEEK) interbody graft is visible
Figure 6
Figure 6
Lateral flexion (a) and extension (b) radiographs of the lumbar spine demonstrating pedicle screw instrumentation and interbody graft at L5–S1 with no significant motion between flexion and extension at the instrumented level
See this image and copyright information in PMC

References

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