PMC3497577_01
Preoperative anteroposterior radiograph. The L5-S1interspinous distance is increased and the interspinous line shows
a stepoff at this level. Avulsion of the L5 left transverse process is
identified (arrow). The left facet joint is not well delineated.
TOORTHJ-6-473_F1.jpg
PMC3497577_01_TOORTHJ-6-473_F1.jpg
F1
Initial lumbosacral anteroposterior radiograph showed avulsion of the L5 left transverse process and obliquity of the lumbar spine on the sacrum, manifest as increase of the L5-S1 interspinous distance and as rotational deformity of the L5 spinous process (Fig. 1).
Axial CT image shows avulsion of the L5 left transverse
process and the lateral half of the pedicle.
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F2
On the right, fracture of the S1 superior articular facet was demonstrated with normal alignment of the facet joint (Figs. 2, 3a, b).
(a, b) CT oblique coronal reformatted sequential images demonstrate the fracture at the root of right superior facet (RS) (arrow), the
normal right inferior facet (RI), the normal (not fractured) LS, the fractured left transverse process (TP). The inferior part of LI is not
identified (comminuted).
TOORTHJ-6-473_F3.jpg
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F3
On the right, fracture of the S1 superior articular facet was demonstrated with normal alignment of the facet joint (Figs. 2, 3a, b).
MRI of the lumbosacral spine. Sagittal T2-weighted midline and off-midline images showing epidural haematoma (curved arrow),
extensive high-signal intensity changes in the posterior ligamentous complex (empty arrow) and discontinuity of the ligamentum flavum
(straight arrow) suggestive of disruption. Notice mild posterior subluxation of L5 on S1.
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F4
Furthermore, it demonstrated disruption of the posterior ligamentous complex including the ligamentum flavum bilaterally, the interspinous and supraspinous ligaments and extensive high-signal intensity traumatic changes of the paraspinous musculature (Fig. 4).
Anteroposterior (a) and lateral (b) postoperative radiographs.
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F5
It was unable to insert a screw at the L5 left pedicle because it was fractured, (Fig. 5a, b).