Traumatic Bilateral L3-4 Facet Dislocation With Open Decompression and Short Segment Fusion

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Trauma Surgery

Background:

• Traumatic lumbar facet dislocations are rare, typically occurring at the lumbosacral junction.
• High-energy flexion-distraction forces cause these injuries, often leading to neurological deficits.
• Bilateral L3-4 facet dislocations are exceptionally uncommon, with limited case reports globally.

Purpose of the Study:

• To report a rare case of bilateral L3-4 facet dislocation.
• To describe the surgical management of this specific injury pattern.
• To discuss treatment options and the lack of a standardized algorithm for such injuries.

Main Methods:

• A 24-year-old male with multisystem trauma from a motor vehicle collision presented with a bilateral L3-4 facet dislocation.
• Initial management involved posterior decompression and short-segment instrumented fusion.
• A subsequent lateral approach was used for interbody fusion at the L3-4 level.

Main Results:

• The patient presented neurologically intact but developed radiculopathy post-injury.
• Surgical intervention included posterior decompression, short-segment fusion, and lateral interbody fusion.
• The patient's outcome and the effectiveness of this combined surgical approach were evaluated.

Conclusions:

• Bilateral L3-4 facet dislocations are rare and challenging injuries requiring prompt surgical intervention.
• A combined posterior decompression/fusion and lateral interbody fusion approach can be effective.
• Individualized treatment considering patient and injury factors is crucial due to the absence of a defined treatment algorithm.