Traumatic complete anterior dislocation at the lumbosacral junction: a case report and literature review
Liu Boling1, Zhang Huang2, Wang Huafeng1, Ye Xiaowei2, Liang Guiqing1, Chen Wei1, Chen Qiyong1
1Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University,Fuzhou 350007, China; 2Fujian University of Traditional Chinese Medicine, Second Clinical Medical College, Fuzhou 350122, China
Abstract：Objective To report a case of traumatic complete anterior dislocation at the lumbosacral junction and the related literatures were reviewed to explore the clinical characteristics, mechanism and treatment strategy of this pattern injury.Methods The clinical data of a 52-year-old woman with traumatic complete anterior dislocation at the lumbosacral junction were retrospectively analyzed. The literatures about traumatic complete anterior dislocation at the lumbosacral junction before January 2019 were searched in CNKI, Weipu, Wanfang and PubMed database by using “创伤性腰骶椎完全性脱位” “创伤性腰骶椎完全滑脱” and “traumatic complete lumbosacral dislocation”, “traumatic lumbosacral spondyloptosis” as key words. A total of 10 English literatures on 10 cases of lumbar 5 vertebral traumatic complete anterior dislocation were included. The clinical features, imaging features, cases of this pattern injury, treatment and clinical prognosis of 10 cases in literatures and 1 case in this paper were summarized and analysed.Results A case of adult female with complete anterior lumbar dislocation and nerve injury due to traffic accident was reported. Simple posterior decompression, reduction and interbody fusion operation were performed. The lumbosacral dislocation was reduced completely after operation. At the follow-up of 6 months after surgery, no loss of reduction and internal fixator were found, and the neurological function of the patients was nearly normal. Eleven cases of traumatic complete anterior dislocation at the lumbosacral junction were involved, including 1 case in this paper and 10 cases reported.There were 9 males and 2 females, age ranged from 18 to 57 years old. Most of them were caused by high-energy violent injuries, which resulted in lumbosacral swelling, pain, activity limitation and neurological deficits. Radiologic imaging showed that the L5 displaced more than 100% anteriorly relative to the sacrum, and most of them were accompanied by posterior spine accessory structure destruction. Operative management consisted of early surgical decompression,reduction, instrumented spinal fusion to restore the stability of lumbosacral segment and improve the neurological function.Conclusions Traumatic complete anterior dislocation at the lumbosacral junction is a rare injury pattern. Its biomechanics is extremely unstable, and most of them are accompanied by neurological deficits. Its mechanism is still controversial. Early surgical decompression, reduction and fusion can improve the prognosis. Although specific surgical methods should be adopted according to specific conditions, posterior decompression, reduction, interbody fusion and internal fixation is a safe and effective method for complete traumatic anterior lumbosacral joint dislocation.
刘伯龄, 张煌, 王华锋, 叶小伟, 梁珪清, 陈伟, 陈齐勇. 创伤性腰5椎体完全性前脱位一例及文献复习[J]. 中华解剖与临床杂志, 2020, 25(2): 152-158.
Liu Boling, Zhang Huang, Wang Huafeng, Ye Xiaowei, Liang Guiqing, Chen Wei, Chen Qiyong. Traumatic complete anterior dislocation at the lumbosacral junction: a case report and literature review. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 152-158.
Arandi NR, Mundis GM Jr, Kabirian N, et al. Traumatic complete lateral dislocation at the lumbosacral junction: a case report[J]. J Spinal Disord Tech, 2015, 28(1): E56-60. DOI:10.1097/BSD.0000000000000084.
[2]
Akesen B, Mutlu M, Kara K, et al. Traumatic lumbosacral spondyloptosis: a case report and review of the literature[J]. Global Spine J, 2014, 4(1): 59-62. DOI:10.1055/s-0033-1357082.
[3]
王华锋, 郑召民. 经皮骶骨翼髂骨钉固定技术研究进展[J]. 中华外科杂志, 2013, 51(7): 661-663. DOI:10.3760/cma.j.issn.0529-5815.2013.07.022.Wang HF, Zheng ZM. Advances in percutaneous ilium fixation of the sacral wing[J]. Chin J Surg, 2013, 51(7): 661-663. DOI:10.3760/cma.j.issn.0529-5815.2013.07.022.
[4]
Gräbe RP. Fracture-dislocation of the lumbosacral spine during a grand mal epileptic seizure. A case report[J]. S Afr Med J, 1988, 74(3): 129-131.
[5]
Van Savage JG, Dahners LE, Renner JB, et al. Fracture-dislocation of the lumbosacral spine: case report and review of the literature[J]. J Trauma, 1992, 33(5): 779-784. DOI:10.1097/00005373-199211000-00033.
[6]
Kaplan SS, Wright NM, Yundt KD, et al. Adjacent fracture-dislocations of the lumbosacral spine: case report[J]. Neurosurgery, 1999, 44(5): 1134-1137. DOI:10.1097/00006123-199905000-00117.
[7]
Carlson JR, Heller JG, Mansfield FL, et al. Traumatic open anterior lumbosacral fracture dislocation. A report of two cases[J]. Spine (Phila Pa 1976), 1999, 24(2): 184-188. DOI:10.1097/00007632-199901150-00021.
Saiki K, Hirabayashi S, Sakai H, et al. Traumatic anterior lumbosacral dislocation caused by hyperextension mechanism in preexisting L5 spondylolysis: a case report and a review of literature[J]. J Spinal Disord Tech, 2006, 19(6): 455-462.
[10]
Daniels AH, Deodhar AA, Hart RA. Traumatic spondyloptosis resulting from high-energy trauma concurrent with a tonic-clonic seizure[J]. Spine J, 2009, 9(1): e1-4. DOI:10.1016/j.spinee.2007.10.030.
[11]
Wangtaphan W, Oo M, Paholpak P, et al. Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report[J]. Spine (Phila Pa 1976), 2012, 37(22): E1410-E1414. DOI:10.1097/BRS.0b013e318268c08a.
[12]
Baek DH, Choi BW, Kim JW. Treatment of traumatic lumbosacral spondyloptosis combined with unstable pelvic ring injury[J]. J Orthop Sci, 2015, 20(4): 776-780. DOI:10.1007/s00776-014-0530-6.
[13]
周田华, 汤逊, 徐永清, 等. L4椎体创伤性完全性滑脱二例[J]. 中华创伤骨科杂志, 2009, (11): 1096-1097. DOI:10.3760/cma.j.issn.1671-7600.2009.11.025.Zhou TH, Tang X, Xu YQ, et al. Complete traumatic olisthy of the L4 vertebral body in 2 cases[J]. Chinese Journal of Orthopaedic Trauma, 2009, (11): 1096-1097. DOI:10.3760/cma.j.issn.1671-7600.2009.11.025.
[14]
张贤, 陈俊君, 葛文杰, 等. 急性创伤性腰椎滑脱症的临床特征及后路手术治疗[J]. 中国脊柱脊髓杂志, 2015, 25(4): 328-332. DOI:10.3969/j.issn.1004-406X.2015.04.08.Zhang X, Chen JJ, Ge WJ, et al. The clinical features and posterior operation for traumatic lumbar spondylolisthesis[J]. Chinese Journal of Spine and Spinal Cord, 2015, 25(4): 328-332. DOI:10.3969/j.issn.1004-406X.2015.04.08.
[15]
王华锋, 郑召民, 陈嵘, 等. 一期后路椎弓根螺钉固定联合前路经腹膜后病灶清除治疗腰骶段脊柱结核[J]. 中国脊柱脊髓杂志, 2016, 26(9): 813-819. DOI:10.3969/j.issn.1004-406X.2016.09.07.Wang HF, Yang CS, Zheng ZM, et al. Anterior debridement and fusion via paramedian retroperitoneal approach combined with posterior pedicle screw fixation for the treatment of lumbosacral junction tuberculosis[J]. Chinese Journal of Spine and Spinal Cord, 2016, 26(9): 813-819. DOI:10.3969/j.issn.1004-406X.2016.09.07.
[16]
王江涛, 韩智敏, 曹凯. 经骶2骶髂螺钉与髂骨螺钉在成人脊柱骨盆固定中应用价值的Meta分析[J]. 中华解剖与临床杂志, 2018, 23(6): 507-512. DOI:10.3760/cma.j.issn.2095-7041.2018.06.011.Wang JT, Han ZM, Cao K. Meta-analysis of clinical efficacy of second sacral alar-iliac fixation and iliac screw fixation in adult spinal pelvis fixation[J].Chin J Anat Clin, 2018, 23(6): 507-512. DOI: 10.3760/cma.j.issn.2095-7041.2018.06.011.
2020, Vol. 25 
