PMC10331613_01
Sagittal (A), cross-sectional (B), and coronal (C) CT images showed the patient was definitely diagnosed with lumbosacral spondyloptosis. The three-dimensional reconstruction was useful in showing the bony structure clearly (D). CT, computed tomography.
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F1
Immediately after the injury, the patient was sent to our hospital by ambulance for treatment and underwent x-ray and computed tomography (CT) scan (Figure 1); the imaging examinations revealed the left 10th and 11th rib, bilateral transverse processes (L2-L5 levels), sacrum, and coccyx and right ilium fractures, and L5 vertebra and S1 vertebra dislocation and separation.
Sagittal (A) and cross-sectional (B) MRI images showed the dural tear and cerebrospinal fluid leakage. MRI, magnetic resonance imaging.
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F2
A lumbosacral vertebra magnetic resonance imaging (MRI) revealed a complete rupture of the L5-S1 intervertebral disc; tear in anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, interspinous ligament, supraspinous ligament, and dural sac; and cerebrospinal fluid (CSF) seepage into the tissue space behind the lumbar spine (Figure 2).
Intraoperative C-arm fluoroscopy revealed that the L5 inferior articular process was locked into the anterior margin of the S1 vertebra (A). Intraoperative C-arm fluoroscopy suggested that the L5 inferior articular process has been removed (B). Intraoperative C-arm fluoroscopy showed a good reduction (C).
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F3
S1 vertebra (Figure 3A), severe dural sac tear had occurred at the L5-S1 level, and only part of cauda equina and filum terminale are continuous; the L5-S1 intervertebral disc had ruptured and prolapsed into the spinal canal. Specific procedures were performed as follows. We found that the bilateral inferior articular processes of L5 was still dislocated in front of the S1 vertebra after C-arm fluoroscopy, and it is particularly difficult to perform the reduction with a screw distractor; so we decided to resect bilateral inferior articular processes of L5 with the assistance of the ultrasonic bone scalpel (Figure 3B). Reduction was attempted again, and the spinal column getting back into normal alignment was observed after C-arm fluoroscopy (Figure 3C).
Sagittal and cross-sectional CT images at the postoperative month 1 (A,B). Lumbar anteroposterior and lateral x-ray radiographs at the postoperative month 1 (C,D). Sagittal and cross-sectional MRI images at the postoperative month 1 (E,F). CT, computed tomography; MRI, magnetic resonance imaging.
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F4
The lumbar x-ray, CT scan, and MRI showed that the internal fixation and lumbar interbody cages were in good position, and there was a small amount of fluid behind the lumbar spine (Figure 4).