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Case Reports
. 2019 Nov 23;20(1):558.
doi: 10.1186/s12891-019-2921-5.

Traumatic bilateral L4-5 facet fracture dislocation: a case presentation with mechanism of injury

Kevin Chi Him Fok  1 , Jason Pui Yin Cheung  2
Affiliations
Case Reports

Traumatic bilateral L4-5 facet fracture dislocation: a case presentation with mechanism of injury

Kevin Chi Him Fok et al. BMC Musculoskelet Disord. .

Abstract

Background: Traumatic bilateral locked facet joints at L4-5 level are a rare entity. A careful review only revealed four case reports. This case presented with an unusual mechanism of injury.

Case presentation: We present a case of a 40-year-old male who suffered bilateral L4-5 traumatic facet fracture dislocation following a fall injury. The dislocation was associated with fractures of bilateral L4 inferior articular processes, left L4 pedicle, L4 spinous process and postero-inferior body of L4. He presented with cauda-equina syndrome and underwent emergency decompression, reduction and instrumented fusion.

Conclusion: The biomechanics of the lumbar spine may differ with each individual. L4-5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury.

Keywords: Jumped facet; L4–5; Locked facet; Traumatic spondylolisthesis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Collision site of metal bar as fulcrum. b XR showing grade II spondylolisthesis of L4 on L5, fracture dislocation of facet joints, and fractures of left transverse processes from L1 through L4, a fracture of posterior inferior L4 vertebral body, spina bifida occulta of L5. c, d. CT scan showing fracture of bilateral L4 inferior articular processes, fracture of left L4 transverese process, left L4 pedicle and the L4 spinous process, L4 vertebral body fragment retropulsion causing severe spinal canal narrowing, and coronally oriented L4/5 facets. e Spontaneous reduction of dislocation upon prone position. f Laminectomy and posterior spinal fusion with instrumentation. g Post-operative XR showing reduction of dislocation
Fig. 2
Fig. 2
Our patient had a similar mechanism of injury as a motor vehicle accident with head-on collision. The points of fixation by seatbelts are replaced by body weights and the momentum of the body is replaced by a fulcrum at the metal bar. Both situations result in a forward motion of the lumbar spine relative to the remainder of the body with hyperextension of the lumbar spine
See this image and copyright information in PMC

References

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