Index to Chiropractic Literature
Index to Chiropractic Literature
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ID 23112
  Title Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: A case report [case report]
Journal J Chiropr Med. 2013 Sep;12(3):191-195
Peer Review Yes
Publication Type Case Report

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.

This abstract is reproduced with the permission of the publisher; click on the above link for free full text.


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