![]() ![]() The initial examination showed a complete anterior fracture dislocation of the L4 vertebral body associated with a comminuted fracture of the cranial endplate of L5 ( Figure 2). ![]() Patient 3 was a 29-year-old soldier who was crushed by a 300 kg object. The patient was asymptomatic and has resumed his activities. The lumbar circumferential 元L5 fusion was complete. Eighteen months after the trauma, the patient completely recovered his neurological function. Eight days after the second surgical procedure, an intervertebral 元L4 and L4L5 fusion was done using a retroperitoneal approach. The L4 reduction was then performed by applying traction to the trans-pedicle screws in L4. Owing to technical difficulties, a provisional osteosynthesis was carried out from L2 to S1 and a second posterior surgical procedure was performed 3 days after the trauma. The initial examination showed a complete anterior fracture dislocation of the fourth lumbar vertebra associated with a comminuted fracture of the cranial endplate of L5 and a rupture of the left ureter. Neurological examination showed a complete right L5 deficit. He complained of severe low-back pain and right lower limb paralysis. Patient 2 was a 19-year-old male who was admitted after a road-traffic accident. ![]() She was able to walk with the help of a bilateral ankle orthoses. The global muscular strength of the lower limbs was evaluated at 3/5 with a spastic component. Eighteen months after the trauma and completing a rehabilitation programme, the neurological recovery was partial with a severe neurological impairment of the lower limbs and severe sphincter disturbance. The reduction of the lumbar dislocation was easily achieved with posterior osteosynthesis from T8 to L5, applying traction to the trans-pedicle screws in 元 ( Figure 1c and d). An open reduction and internal fixation with a posterior approach was performed 6 h after the trauma. The initial imaging work up showed a complete anterior fracture dislocation of the third lumbar vertebra ( Figure 1a and b), a burst fracture of L2 and T10, a cranial end-plate fracture of L4. ![]() Neurological evaluation showed a complete flaccid paraplegia with absence of rectal tone. Patient 1 was a 32-year-old female who jumped out of a window and presented with multiple complex spinal injuries. Especially in young patients, severe disc lesions secondary to the wide vertebral displacement make it necessary to perform circumferential fusion. Reduction of vertebral dislocation can be difficult to achieve and it is therefore mandatory to perform complete arthrectomy of the injured levels before reduction. The therapeutic goal is to achieve emergent vertebral alignment, neurological decompression and solid spinal fusion. In spite of the severe injury, two neurological deficits improved thanks to pedicular fractures, which widen the canal. In one case of a multilevel injury, an extensive instrumented spinal fusion was necessary. The diagnosis was made on plain radiographs. In all the cases, the vertebral dislocation was responsible for a severe neurological deficit and all patients had severe associated lesions. The data of three cases of complete spinal anterior dislocation with a 100% anterior slip of the vertebral body were retrospectively reviewed. Three cases of this uncommon lesion are reported. Severe trauma can be responsible for a complete spinal anterior dislocation with a 100% anterior slip of the vertebral body. ![]()
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