Traumatic Lumbosacral Dislocations and Management Strategies

Traumatic dislocations of the lumbosacral junction represent an uncommon but catastrophic subset of spinal injuries, typically arising from high-energy events such as falls from height or motor vehicle collisions. Disruption of ligamentous complexes and facet joint articulations at L5–S1 may occur with or without associated fractures of the vertebral bodies or posterior elements. Clinical presentation ranges from isolated back pain to severe neurological deficits, including cauda equina syndrome. Prompt recognition through a combination of plain radiography, computed tomography and magnetic resonance imaging is essential to delineate the extent of osseous and soft-tissue injury. Management strategies have evolved overwhelmingly towards operative intervention, with open or minimally invasive techniques facilitating reduction, decompression of neural elements, and rigid stabilisation. Posterior pedicle screw fixation, transforaminal or posterior lumbar interbody fusion, and in select cases anterior approaches are employed to restore alignment and promote arthrodesis. Despite advances in surgical technique and perioperative care, these injuries carry significant risks of persistent pain, neurological impairment and hardware complications. Long-term outcomes remain variable and are influenced by the initial severity of displacement, timing of surgery, and rehabilitation protocols.

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Traumatic Lumbosacral Dislocations and Management Strategies publication trend

The graph below shows the total number of articles in traumatic lumbosacral dislocations and management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Lumbosacral dislocation: Displacement of the lowest lumbar vertebra relative to the sacrum, involving ligamentous and facet joint disruption.

Spondylolisthesis: Forward slippage of one vertebral body over the one below, graded by percentage displacement.

Spondyloptosis: Complete translation of a vertebral body beyond 100% displacement over the subjacent segment.

Interbody fusion: Surgical technique placing graft or cage between vertebral bodies to achieve bony fusion and stability.

Pedicle screw instrumentation: Use of screws anchored in the vertebral pedicles connected by rods to stabilise spinal segments.

Reduction: Realignment of displaced vertebral elements to restore normal anatomy.

Hyperflexion-distraction injury: Mechanism in which the spine is forcibly flexed and stretched, leading to ligamentous and bony failure.

References

1. Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management. Advances in Orthopedics (2018).
2. Traumatic Spondylolisthesis of the Fourth Lumbar Vertebra Without Neurologic Deficit or Fracture of the Posterior Elements. Cureus (2021).
3. Case report: Traumatic lumbosacral spondyloptosis with locked L5 inferior articular process. Frontiers in Surgery (2023).
4. Anterior Traumatic Lumbosacral Dislocation: A Case Report. Cureus (2023).