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Traumatic posterior lumbosacral spondyloptosis in a six-year-old: a case report and review of the literature.
Spine (Phila Pa 1976) 2009; 34(17):E629-34S

Abstract

STUDY DESIGN

Report of a traumatic posterior lumbosacral spondyloptosis in a 6-year-old.

OBJECTIVES

To describe this type of fracture-dislocation in children. To evaluate a possible trauma mechanism. To evaluate specific characteristics of this type of lesion in children.

SUMMARY OF BACKGROUND DATA

Fractures of the lumbar spine in children are rare. They are without exception caused by high-energy trauma. Fracture-dislocations mostly occur in the anterior direction. There are several reports of traumatic retrolisthesis in adults. To our knowledge, this is the first report of a retrolisthesis at the lumbosacral junction in a child.

METHODS

While sitting, a 6-year-old boy was hit by a truck. He presented with a flaccid paraparesis below L3. Radiologic investigations showed a posterior spondyloptosis at L5-S1. He was treated by open reduction with a pediatric posterior spinal instrumentation and posterolateral grafting.

RESULTS

After 1 year, the patient showed good radiologic fracture reduction and graft incorporation. There was no pain in the lumbar area. There was still a complete neurologic deficit beneath the L3 level, with loss of bladder and anal sphincter function. The patient was entered into a children's rehabilitation program 5 weeks after surgery and is continuously improving his overall functional level.

CONCLUSION

Traumatic retrolisthesis of the lumbosacral spine is extremely rare, especially in children. We believe shear force while sitting is the key traumatic factor. We believe a simple posterior fusion with posterolateral grafting is sufficient to stabilize the spine in children. Extensive soft tissue damage causes an elevated risk of infection. Because of root avulsion, the level of paralysis can be several levels higher than the level of dislocation.

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    Authors+Show Affiliations

    Verhelst L
    Department of Orthopedic Surgery, University Hospital Pellenberg, Leuven, Belgium. lukverhelst@hotmail.com
    Ackerman P
    No affiliation info available
    Van Meirhaeghe J
    No affiliation info available

    MeSH

    Accidents, TrafficBone TransplantationChildDecompression, SurgicalFecal IncontinenceHumansInternal FixatorsJoint DislocationsLumbar VertebraeMaleParaplegiaPolyradiculopathyRadiographyReconstructive Surgical ProceduresSacrumSpinal CanalSpinal FracturesSpinal FusionSpinal Nerve RootsTreatment OutcomeUrinary Bladder, NeurogenicWounds and Injuries

    Pub Type(s)

    Case Reports
    Journal Article
    Review

    Language

    eng

    PubMed ID

    19644323

    Citation

    Verhelst, Luk, et al. "Traumatic Posterior Lumbosacral Spondyloptosis in a Six-year-old: a Case Report and Review of the Literature." Spine, vol. 34, no. 17, 2009, pp. E629-34.
    Verhelst L, Ackerman P, Van Meirhaeghe J. Traumatic posterior lumbosacral spondyloptosis in a six-year-old: a case report and review of the literature. Spine. 2009;34(17):E629-34.
    Verhelst, L., Ackerman, P., & Van Meirhaeghe, J. (2009). Traumatic posterior lumbosacral spondyloptosis in a six-year-old: a case report and review of the literature. Spine, 34(17), pp. E629-34. doi:10.1097/BRS.0b013e3181aa2e1a.
    Verhelst L, Ackerman P, Van Meirhaeghe J. Traumatic Posterior Lumbosacral Spondyloptosis in a Six-year-old: a Case Report and Review of the Literature. Spine. 2009 Aug 1;34(17):E629-34. PubMed PMID: 19644323.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Traumatic posterior lumbosacral spondyloptosis in a six-year-old: a case report and review of the literature. AU - Verhelst,Luk, AU - Ackerman,Pieter, AU - Van Meirhaeghe,Jan, PY - 2009/8/1/entrez PY - 2009/8/1/pubmed PY - 2009/11/17/medline SP - E629 EP - 34 JF - Spine JO - Spine VL - 34 IS - 17 N2 - STUDY DESIGN: Report of a traumatic posterior lumbosacral spondyloptosis in a 6-year-old. OBJECTIVES: To describe this type of fracture-dislocation in children. To evaluate a possible trauma mechanism. To evaluate specific characteristics of this type of lesion in children. SUMMARY OF BACKGROUND DATA: Fractures of the lumbar spine in children are rare. They are without exception caused by high-energy trauma. Fracture-dislocations mostly occur in the anterior direction. There are several reports of traumatic retrolisthesis in adults. To our knowledge, this is the first report of a retrolisthesis at the lumbosacral junction in a child. METHODS: While sitting, a 6-year-old boy was hit by a truck. He presented with a flaccid paraparesis below L3. Radiologic investigations showed a posterior spondyloptosis at L5-S1. He was treated by open reduction with a pediatric posterior spinal instrumentation and posterolateral grafting. RESULTS: After 1 year, the patient showed good radiologic fracture reduction and graft incorporation. There was no pain in the lumbar area. There was still a complete neurologic deficit beneath the L3 level, with loss of bladder and anal sphincter function. The patient was entered into a children's rehabilitation program 5 weeks after surgery and is continuously improving his overall functional level. CONCLUSION: Traumatic retrolisthesis of the lumbosacral spine is extremely rare, especially in children. We believe shear force while sitting is the key traumatic factor. We believe a simple posterior fusion with posterolateral grafting is sufficient to stabilize the spine in children. Extensive soft tissue damage causes an elevated risk of infection. Because of root avulsion, the level of paralysis can be several levels higher than the level of dislocation. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/19644323/Traumatic_posterior_lumbosacral_spondyloptosis_in_a_six_year_old:_a_case_report_and_review_of_the_literature_ L2 - http://Insights.ovid.com/pubmed?pmid=19644323 DB - PRIME DP - Unbound Medicine ER -