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Traumatic Spondylopelvic Dissociation: A Report of Two Cases of Spondylolisthesis at L5-S1 and Review of Literature.

Robbins M, Mallon Z, Roberto R, Patel R, Gupta M, Klineberg E - Global Spine J (2015)

Bottom Line: Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes.Operative stabilization was necessary, and both patients were treated with open reduction internal fixation.These cases offer insight into the management of anterior and posterior L5-S1 spondylopelvic dissociation.

View Article: PubMed Central - PubMed

Affiliation: University of California, Davis Medical Center, Sacramento, California, United States.

ABSTRACT
Study Design Retrospective chart review and review of literature. Objective Few case reports of traumatic L5-S1 displacement have been presented in the literature. Here we present two cases of traumatic spondylolisthesis showing both anterior and posterior displacement, the treatment algorithm, and a review of the literature. Methods The authors conducted a retrospective review of representative patients and a literature review of traumatic spondylolisthesis at the L5-S1 junction. Two representative patients were identified with traumatic spondylolisthesis: one with an anterior dissociation, and the other with a posterior dissociation. Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes. Operative stabilization was necessary, and both patients were treated with open reduction internal fixation. The patient with posterior dissociation had complete recovery without neurologic sequelae. The patient with anterior dissociation had persistent bilateral L5-S1 radiculopathy with intact rectal tone, due to neurologic compression. Conclusions Few cases of traumatic spondylopelvic dissociation that are isolated to the L5-S1 disk space are described in the literature. We examined both an anterior and a posterior dissociation and treated both with L5-S1 posterior spinal fusion. The patient with anterior dissociation had persistent L5-S1 root injury; however, the patient with posterior dissociation had no neurologic deficits. This is the opposite of what is expected based on anatomy. These cases offer insight into the management of anterior and posterior L5-S1 spondylopelvic dissociation.

No MeSH data available.


Related in: MedlinePlus

(A) Axial computed tomography image showing L5–S1 bilateral facet fractures and L5 spinous process fracture. (B) Sagittal computed tomography showing L5–S1 anterolisthesis.
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FI1400026cr-2: (A) Axial computed tomography image showing L5–S1 bilateral facet fractures and L5 spinous process fracture. (B) Sagittal computed tomography showing L5–S1 anterolisthesis.

Mentions: A 49-year-old man was sleeping on a loading dock while intoxicated and was crushed by a semitruck. He was taken to a local emergency department where he was evaluated and released to jail without an injury diagnosis. Although incarcerated, he began to experience worsening leg and back pain. He was then brought to our institution by ambulance from jail complaining of low back pain, left hip pain, and left thigh pain, with decreased perianal and penile sensation but no urinary incontinence. Rectal tone was absent, with a normal bulbocavernosus reflex, but he was otherwise neurologically intact. The initial radiographs showed bilateral L5–S1 facet joint fractures with grade 2 L5–S1 anterolisthesis, as well as L4 and L5 spinous and transverse process fractures (Fig. 1). Computed tomography (CT) confirmed the anterior dissociation of the lumbar spine from the sacrum (Fig. 2).


Traumatic Spondylopelvic Dissociation: A Report of Two Cases of Spondylolisthesis at L5-S1 and Review of Literature.

Robbins M, Mallon Z, Roberto R, Patel R, Gupta M, Klineberg E - Global Spine J (2015)

(A) Axial computed tomography image showing L5–S1 bilateral facet fractures and L5 spinous process fracture. (B) Sagittal computed tomography showing L5–S1 anterolisthesis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472281&req=5

FI1400026cr-2: (A) Axial computed tomography image showing L5–S1 bilateral facet fractures and L5 spinous process fracture. (B) Sagittal computed tomography showing L5–S1 anterolisthesis.
Mentions: A 49-year-old man was sleeping on a loading dock while intoxicated and was crushed by a semitruck. He was taken to a local emergency department where he was evaluated and released to jail without an injury diagnosis. Although incarcerated, he began to experience worsening leg and back pain. He was then brought to our institution by ambulance from jail complaining of low back pain, left hip pain, and left thigh pain, with decreased perianal and penile sensation but no urinary incontinence. Rectal tone was absent, with a normal bulbocavernosus reflex, but he was otherwise neurologically intact. The initial radiographs showed bilateral L5–S1 facet joint fractures with grade 2 L5–S1 anterolisthesis, as well as L4 and L5 spinous and transverse process fractures (Fig. 1). Computed tomography (CT) confirmed the anterior dissociation of the lumbar spine from the sacrum (Fig. 2).

Bottom Line: Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes.Operative stabilization was necessary, and both patients were treated with open reduction internal fixation.These cases offer insight into the management of anterior and posterior L5-S1 spondylopelvic dissociation.

View Article: PubMed Central - PubMed

Affiliation: University of California, Davis Medical Center, Sacramento, California, United States.

ABSTRACT
Study Design Retrospective chart review and review of literature. Objective Few case reports of traumatic L5-S1 displacement have been presented in the literature. Here we present two cases of traumatic spondylolisthesis showing both anterior and posterior displacement, the treatment algorithm, and a review of the literature. Methods The authors conducted a retrospective review of representative patients and a literature review of traumatic spondylolisthesis at the L5-S1 junction. Two representative patients were identified with traumatic spondylolisthesis: one with an anterior dissociation, and the other with a posterior dissociation. Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes. Operative stabilization was necessary, and both patients were treated with open reduction internal fixation. The patient with posterior dissociation had complete recovery without neurologic sequelae. The patient with anterior dissociation had persistent bilateral L5-S1 radiculopathy with intact rectal tone, due to neurologic compression. Conclusions Few cases of traumatic spondylopelvic dissociation that are isolated to the L5-S1 disk space are described in the literature. We examined both an anterior and a posterior dissociation and treated both with L5-S1 posterior spinal fusion. The patient with anterior dissociation had persistent L5-S1 root injury; however, the patient with posterior dissociation had no neurologic deficits. This is the opposite of what is expected based on anatomy. These cases offer insight into the management of anterior and posterior L5-S1 spondylopelvic dissociation.

No MeSH data available.


Related in: MedlinePlus