Table 1 Previous reports of L4-5 facet joint dislocation
From: Traumatic bilateral L4-5 facet fracture dislocation: a case presentation with mechanism of injury
Author (year) | Patient (age/sex) | Description of injury | Presenting symptoms | Bony injury | Soft tissue injury | Operation | Outcome | Proposed mechanism |
|---|---|---|---|---|---|---|---|---|
Mori [1] (2002) | 32/F | MVA, head-on collision Seatbelt worn | Lower back and abdominal pain. No neurological deficit | Bilateral L4–5 facet dislocation, Fractured right L4 and L5 transverse processes | Posterior longitudinal ligament disrupted. capsules torn, supra/interspinous ligaments torn, ligamentum flavum partially ruptured Dura intact | Reduction by resecting upper facet of L5, PSF | 1.5 years: no low back pain, no neurological deficit | Hyperflexion injury, fulcrum at L4–5 level Weak lumbar paravertebral muscles to prevent sudden violent flexion and distraction |
Song [3] (2005) | 47/F | MVA, head-on collision. Seatbelt worn | Low back pain, No neurological deficit | Bilateral L4–5 facet dislocation, Fractured left L5 transverse process, Anterosuperior fracture fragment of L5 body | Ruptured posterior ligament complex and posterior muscles Disrupted capsules. Dura intact | Open reduction, Laminectomy, Posterior interbody fusion with iliac bone PSF, PLF | 10 months: Fusion achieved | L4–5 facet located more sagittally, L5 more stable due to binding of iliolumbar and sacroiliac ligaments |
Deniz [2] (2008) | 44/M | MVA, crashed into a tree, thrown onto the ground | Low back pain, Numbness and weakness in both extremities, claudication symptoms | Bilateral L4–5 facet dislocation, Fractured bilateral L4 inferior articular processes | L4–5 foraminal disc herniation | Open reduction, Decompression, Posterior interbody fusion with cages PLF, PSF | 3 months: symptoms free | Extension and axial load |
Zenonos [4] (2016) | 36/M | MVA, head-on collision. Seatbelt worn | No neurological deficit | Bilateral L4–5 facet dislocation, Fractured right L5 superior articular process, Fractured right L1-L5 transverse processes Fractured L4 spinous process Anterosuperior fracture fragment of L5 body | Ruptured L3-S1 interspinous and supraspinous ligaments, Ruptured posterior and anterior longitudinal ligaments, L4–5 disc rupture | Reduction by removing superior L5 facets, Laminectomy, PSF, PLF | 3 months; no back pain, no neurological deficit | Extension-distraction forces |