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Adjacent fracture-dislocations of the lumbosacral spine: case report.

OBJECTIVE AND IMPORTANCE
Traumatic fracture-dislocations of the lumbosacral junction are rare, with all previously reported cases involving fracture-dislocations at a single level. No cases of multiple fracture-dislocations of contiguous spinal segments in the lumbosacral spine have been reported. A case of traumatic adjacent fracture-dislocations of the fifth lumbar segment is presented.


CLINICAL PRESENTATION
An 18-year-old male patient sustained open lumbar spinal trauma after a motor vehicle accident. A neurological examination revealed an L4 level. Radiographic evaluation of the spine revealed a three-column injury at L5 with spondyloptosis of the L5 vertebral body. Aorto-ilio-femoral angiography revealed no evidence of vascular injury.


INTERVENTION
The patient was treated with a combined anterior and posterior approach in a two-stage operation. Six months postoperatively, he was neurologically unchanged; however, he was able to walk with the aid of a cane. Plain films revealed normal alignment of the lumbosacral spine.


CONCLUSION
The management of traumatic lumbosacral fracture-dislocations requires careful consideration of retroperitoneal structures and possible exploration of the iliac vessels in addition to spinal reconstruction.