LUMBOSACRAL DISLOCATION INJURIES AND THEIR MANAGEMENT: EXPERIENCE AND RECOMMENDATIONS

Abstract

Purpose: Lumbosacral dislocation injuries are rare. Severe trauma disrupts the mechanically stable lumbosacral junction, rendering the injuries particularly unstable. Aggressive surgical management has been recommended. We present a review of our experience with these uncommon injuries defining injury patterns, surgical strategies and outcomes.

Methodology: Six patients were treated at Auckland Hospital in the last decade. Thorough review and literature search were performed to revise recommendations for management.

Results: All injuries were associated with high-energy trauma. In two cases there was evidence of previous spondylolysis, with dramatic progression after injury. All cases were surgically treated with decompression, reduction as indicated, and fusion with instrumentation. The only instrumentation failure occurred when reduction reconstituted disc height without attention to reconstruction of the severely mechanically compromised intervertebral disc. Satisfactory recovery of nerve root injury occurred in all but one case. Major cauda equina damage did not occur. Correlations with previously described classification systems for this injury were poor, and often showed injuries to span grades.

Conclusions: These highly unstable injuries require a high index of suspicion, and aggressive surgical management of these highly unstable injuries is warranted, yielding satisfactory outcomes. Existing classification systems are of little value prognostically, or in planning treatment, and it is better to classify and treat these injuries specifically relating to the anatomical injury patterns. The severe disruption to the intervertebral disc warrants special consideration with attention to a stable reduction position or three-column reconstruction. Spondylolysis may represent a predisposing factor.