L4-L5 Facet Dislocation Treated in a Delayed Fashion with Excellent Early Clinical Results

Area of Science:

• Orthopedic Surgery
• Spinal Trauma
• Neurosurgery

Background:

• Lumbar facet fracture-dislocations are rare, severe spinal injuries.
• Limited literature exists on delayed surgical intervention for neurologically intact patients.
• Optimal operative techniques for anatomic reduction remain undefined.

Observation:

• A case of L4-L5 facet fracture-dislocation in a 38-year-old female is presented.
• Delayed surgery was performed due to anesthesia risks associated with recent drug use.
• An adjunctive technique involving partial resection of the superior L5 pedicle was utilized for reduction.

Findings:

• The patient achieved an excellent clinical outcome with delayed open reduction and posterior instrumentation and fusion.
• Post-operatively, the patient remained motor intact with only transient L5 dermatome hypesthesia.
• Partial pedicle resection proved to be a safe and effective reduction method in this case.

Implications:

• Delayed surgical intervention can be successful for lumbar facet fracture-dislocations in medically stable, neurologically intact patients.
• Consideration of patient medical stability is crucial before surgical intervention.
• Partial pedicle resection represents a viable technique for specific fracture-dislocation patterns.