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

Schirmer CM, Bisson EF - Surg Neurol Int (2011)

Bottom Line: We describe a case of a unilateral perched L5-S1 facet causing axial back pain and radiculopathy provoked by motion.Postoperatively, the patient reported improvement in her pain.This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Neurosurgery, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts, USA.

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.

No MeSH data available.


Related in: MedlinePlus

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
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Figure 0006: 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

Mentions: Surgical intervention was undertaken because of the presence of clinical instability and her TLICS score. We found obvious disruption of the posterior tension band, including the interspinous ligaments between L4, L5, and S1 with associated soft tissue hematoma. After subperiosteal dissection, the naked superior articular process of S1 was visible, with the most caudal aspect of the inferior articular process of L5 lying cephalad and ventral to it, causing a clockwise rotation of L5. Reduction was accomplished with a complete facetectomy on the right followed by internal fixation with interbody graft and pedicle screw instrumentation at the L5–S1 level, facilitating complete decompression of the S1 nerve root [Figure 5]. Postoperatively, the patient reported immediate and sustained improvement in her back and leg pain. Dynamic X-rays obtained at 6 months showed no significant motion at the operated level [Figure 6].


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

Schirmer CM, Bisson EF - Surg Neurol Int (2011)

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
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3050071&req=5

Figure 0006: 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
Mentions: Surgical intervention was undertaken because of the presence of clinical instability and her TLICS score. We found obvious disruption of the posterior tension band, including the interspinous ligaments between L4, L5, and S1 with associated soft tissue hematoma. After subperiosteal dissection, the naked superior articular process of S1 was visible, with the most caudal aspect of the inferior articular process of L5 lying cephalad and ventral to it, causing a clockwise rotation of L5. Reduction was accomplished with a complete facetectomy on the right followed by internal fixation with interbody graft and pedicle screw instrumentation at the L5–S1 level, facilitating complete decompression of the S1 nerve root [Figure 5]. Postoperatively, the patient reported immediate and sustained improvement in her back and leg pain. Dynamic X-rays obtained at 6 months showed no significant motion at the operated level [Figure 6].

Bottom Line: We describe a case of a unilateral perched L5-S1 facet causing axial back pain and radiculopathy provoked by motion.Postoperatively, the patient reported improvement in her pain.This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Neurosurgery, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts, USA.

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.

No MeSH data available.


Related in: MedlinePlus