Dynamic posterior stabilization for traumatic lumbar facet fracture: A case report

This case report describes an 18-year-old woman who presented after a high-speed motor vehicle collision with a large displaced right L5 superior facet fracture, noted to be neurologically intact. She sustained multiple associated injuries, including small-bowel trauma with hemoperitoneum requiring exploratory laparotomy and double enterectomy. Following a trial of conservative management with thoracolumbosacral orthosis (TLSO), upright radiographs demonstrated progressive L4-5 coronal and sagittal deformity with facet distraction, her neurologic examination remained normal throughout follow-up. Given her age and the concern for adjacent-segment disease with fusion, we proceeded with total posterior spine (TOPS) arthroplasty at the level of L4-L5. Surgery included laminectomy, bilateral complete facetectomies, pedicle-screw instrumentation, and TOPS implantation. The postoperative course was uncomplicated, with intact neurology and progressive improvement in mobility. This case describes the novel utilization of motion-preserving posterior arthroplasty in traumatic facet injury, allowing for deformity correction while potentially minimizing the long-term morbidity associated with lumbar fusion.