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. 2013 Sep;12(3):191-5.
doi: 10.1016/j.jcm.2013.10.009.

Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: a case report

Yaoki Nakao  1 , Tomomichi Kajino  2
Affiliations

Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: a case report

Yaoki Nakao et al. J Chiropr Med. 2013 Sep.

Abstract

Objective: Lumbar fracture-dislocations are rare and invariably due to high-energy trauma. The purpose of this study is to report the surgical management of a man with lateral lumbar dislocations in 2 noncontiguous lesions.

Clinical features: A 49-year-old Asian man was crushed by a bulldozer. The patient was transported to a major medical center where he was found to be conscious, and the primary spinal injuries were fracture-dislocation of L1-L2 and L4-L5. His preoperative neurologic status showed a partial paraparesis to all motor groups of the lower extremities bilaterally. His radiological and operative findings showed a rupture of the thoracolumbar fascia and latissimus dorsi muscle, left L1-L2 dislocated facet, right L4-5 facet fracture, and dural tear.

Intervention and outcome: The patient underwent a posterior reduction, decompression, instrumentation, and fusion surgery from T12 to S1 with autologous bone graft and pedicle screw instrumentation. Postoperatively, his neurologic status improved, allowing him to be ambulatory using a Lofstrand crutch with improved lumbosacral alignment being well maintained. Two weeks postoperatively, the patient regained voluntary bowel and bladder function. At the 1-year follow-up evaluation, his motor power was full in the left leg; however, sensation to pin prick remained lost on the right L5 and S1 distributions. He continued to ambulate using a Lofstrand crutch.

Conclusion: Lateral lumbar fracture-dislocation at 2 noncontiguous levels is an unusual injury that results from high-energy trauma. Prompt recognition of the injuries, reduction of the fracture-dislocations, and posterior stabilization are recommended for neural decompression, spinal alignment, and long-term stabilization.

Keywords: Back injuries; Spinal fractures.

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Figures

Fig 1
Fig 1
Preoperative CT showed L1-L2 and L4-L5 lateral fracture-dislocations. L1 showed right lateral listhesis with right-sided perched facet and left-sided facet fracture; L4 showed left lateral listhesis with right-sided facet fracture and left-sided facet dislocation.
Fig 2
Fig 2
Postoperative plain film radiograph.
See this image and copyright information in PMC

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