Traumatic posterior lumbosacral spondyloptosis in a six-year-old: a case report and review of the literature.
METHODS
Report of a traumatic posterior lumbosacral spondyloptosis in a 6-year-old.


OBJECTIVE
To describe this type of fracture-dislocation in children. To evaluate a possible trauma mechanism. To evaluate specific characteristics of this type of lesion in children.


BACKGROUND
Fractures of the lumbar spine in children are rare. They are without exception caused by high-energy trauma. Fracture-dislocations mostly occur in the anterior direction. There are several reports of traumatic retrolisthesis in adults. To our knowledge, this is the first report of a retrolisthesis at the lumbosacral junction in a child.


METHODS
While sitting, a 6-year-old boy was hit by a truck. He presented with a flaccid paraparesis below L3. Radiologic investigations showed a posterior spondyloptosis at L5-S1. He was treated by open reduction with a pediatric posterior spinal instrumentation and posterolateral grafting.


RESULTS
After 1 year, the patient showed good radiologic fracture reduction and graft incorporation. There was no pain in the lumbar area. There was still a complete neurologic deficit beneath the L3 level, with loss of bladder and anal sphincter function. The patient was entered into a children's rehabilitation program 5 weeks after surgery and is continuously improving his overall functional level.


CONCLUSIONS
Traumatic retrolisthesis of the lumbosacral spine is extremely rare, especially in children. We believe shear force while sitting is the key traumatic factor. We believe a simple posterior fusion with posterolateral grafting is sufficient to stabilize the spine in children. Extensive soft tissue damage causes an elevated risk of infection. Because of root avulsion, the level of paralysis can be several levels higher than the level of dislocation.
Verhelst
Luk
L
Department of Orthopedic Surgery, University Hospital Pellenberg, Leuven, Belgium. lukverhelst@hotmail.com
Ackerman
Pieter
P
Van Meirhaeghe
Jan
J
D000063:Accidents, Traffic; D016025:Bone Transplantation; D002648:Child; D019299:Decompression, Surgical; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008297:Male; D010264:Paraplegia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011128:Polyradiculopathy / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011859:Radiography; D019651:Plastic Surgery Procedures; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D013123:Spinal Fusion; D013126:Spinal Nerve Roots / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology; D014947:Wounds and Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology