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Case Reports
. 2023 Jun 26:10:1174169.
doi: 10.3389/fsurg.2023.1174169. eCollection 2023.

Case report: Traumatic lumbosacral spondyloptosis with locked L5 inferior articular process

Tao Tang #  1 , Yuchi Liu #  2 , Jian Cao  2 , Tianlong Wu  2   3   4 , Dingwen He  2   3   4 , Xigao Cheng  2   3   4 , Shuihua Xie  1
Affiliations
Case Reports

Case report: Traumatic lumbosacral spondyloptosis with locked L5 inferior articular process

Tao Tang et al. Front Surg. .

Abstract

Background: Traumatic lumbosacral spondyloptosis is a very rare spinal disease caused by high-energy trauma. We report a case of traumatic lumbosacral spondyloptosis with locked L5 inferior articular process.

Case presentation: A 33-year-old man presented with multisite pain for 6 h following waist trauma and was admitted to the hospital. He suffered multiple injuries from severe impact on the waist after driving an out of control forklift truck. Preoperative imaging examinations revealed that the patient was diagnosed with traumatic lumbosacral spondyloptosis and the L5 inferior articular process was locked into the anterior margin of the S1 vertebra. A posterior instrumentation, decompression of the cauda equina, and interbody fusion procedure was performed. The patient received hyperbaric oxygen and rehabilitation treatment 10 days after the surgery. At the 6-month postoperative follow-up, the muscle strength of the lower limbs was improved, the patient had no numbness of both lower limbs, and the urinary retention symptom was significantly improved. The American Spinal Injury Association grade improved from grade C preoperatively to grade D postoperatively. As far as we know, there have been no relevant reports on traumatic lumbosacral spondyloptosis with locked L5 inferior articular process yet.

Conclusion: We believe that the hyperflexion and shear forces were the potential causes of this injury. In addition, the preoperative imaging examinations should be evaluated carefully. If the inferior articular process of L5 were locked, we suggest removing the bilateral inferior articular processes first and then perform reduction.

Keywords: case report; lumbosacral dislocation; posterior lumbar fusion; reduction; traumatic lumbosacral spondyloptosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Sagittal (A), cross-sectional (B), and coronal (C) CT images showed the patient was definitely diagnosed with lumbosacral spondyloptosis. The three-dimensional reconstruction was useful in showing the bony structure clearly (D). CT, computed tomography.
Figure 2
Figure 2
Sagittal (A) and cross-sectional (B) MRI images showed the dural tear and cerebrospinal fluid leakage. MRI, magnetic resonance imaging.
Figure 3
Figure 3
Intraoperative C-arm fluoroscopy revealed that the L5 inferior articular process was locked into the anterior margin of the S1 vertebra (A). Intraoperative C-arm fluoroscopy suggested that the L5 inferior articular process has been removed (B). Intraoperative C-arm fluoroscopy showed a good reduction (C).
Figure 4
Figure 4
Sagittal and cross-sectional CT images at the postoperative month 1 (A,B). Lumbar anteroposterior and lateral x-ray radiographs at the postoperative month 1 (C,D). Sagittal and cross-sectional MRI images at the postoperative month 1 (E,F). CT, computed tomography; MRI, magnetic resonance imaging.
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