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Traumatic L4-5 bilateral locked facet joints
Georgios A Zenonos1, Nitin Agarwal1, Edward A Monaco1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Suite B-400, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
Summary
Traumatic bilateral locked facet joints are extremely rare lumbar spine injuries. This case report details a severe L4-5 facet fracture dislocation and its successful surgical management.
Area of Science:
- Orthopedic Surgery
- Spinal Biomechanics
- Traumatology
Background:
- Traumatic bilateral locked facet joints in the lumbar spine are exceptionally rare, with only three prior case reports documented.
- Understanding the biomechanics of lumbar facet joint injuries is crucial for diagnosis and treatment.
Observation:
- A 36-year-old male sustained bilateral L4-5 facet fracture dislocations after a motor vehicle collision.
- The injury involved posterior element disruption, Grade II anterolisthesis, and an epidural hematoma causing significant canal stenosis.
- Despite the severe injury, the patient presented neurologically intact.
Findings:
- The case highlights a unique traumatic bilateral locked facet joint injury at L4-5.
- Surgical intervention included open reduction, L3 to S1 pedicle screw fixation, and arthrodesis.
- The patient's neurological status remained intact throughout the presentation and initial management.
Implications:
- This case expands the understanding of rare lumbar spine injuries and their mechanisms.
- Effective surgical stabilization is critical for managing such highly unstable injuries.
- Further research into the biomechanics of facet joint dislocations may inform future treatment strategies.
