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Delayed bilateral facet dislocation at L4-5: A case report.

Hyung-Youl Park¹, Kee-Yong Ha, Young-Hoon Kim

¹Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon Department of Orthopedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, The Inje University, Seoul, Korea.

|September 22, 2018

Summary

This case report details the first instance of delayed bilateral facet dislocation at L4-L5 in the lumbar spine, highlighting the importance of the posterior ligament complex (PLC) in lower back injuries.

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Area of Science:

Spine Surgery
Traumatology
Orthopedics

Background:

Traumatic bilateral facet dislocation in the lumbar spine is rare.
Most reported cases involve acute dislocations.
This study presents the first case of delayed bilateral facet dislocation at L4-L5.

Observation:

A 34-year-old woman experienced persistent back pain and kyphosis after a collision, despite conservative treatment.
Imaging revealed an L5 superior articular process fracture and posterior ligament complex (PLC) injury.
Radiographs showed locked facet dislocation with kyphotic deformity.

Findings:

Operative findings confirmed L4-L5 bilateral facet dislocation and PLC rupture.
Surgical reduction and posterior interbody fusion at L4-L5 resulted in a satisfactory clinical outcome.

Implications:

Injury to the PLC in the lower lumbar spine requires careful attention due to potential sequelae.
The lumbosacral region's transition from lordosis to kyphosis may be linked to such injuries.