title: Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: a case report.
abstract: OBJECTIVE
  Lumbar fracture-dislocations are rare and invariably due to high-energy trauma. The purpose of this study is to report the surgical management of a man with lateral lumbar dislocations in 2 noncontiguous lesions.
  
  
  METHODS
  A 49-year-old Asian man was crushed by a bulldozer. The patient was transported to a major medical center where he was found to be conscious, and the primary spinal injuries were fracture-dislocation of L1-L2 and L4-L5. His preoperative neurologic status showed a partial paraparesis to all motor groups of the lower extremities bilaterally. His radiological and operative findings showed a rupture of the thoracolumbar fascia and latissimus dorsi muscle, left L1-L2 dislocated facet, right L4-5 facet fracture, and dural tear.
  
  
  RESULTS
  The patient underwent a posterior reduction, decompression, instrumentation, and fusion surgery from T12 to S1 with autologous bone graft and pedicle screw instrumentation. Postoperatively, his neurologic status improved, allowing him to be ambulatory using a Lofstrand crutch with improved lumbosacral alignment being well maintained. Two weeks postoperatively, the patient regained voluntary bowel and bladder function. At the 1-year follow-up evaluation, his motor power was full in the left leg; however, sensation to pin prick remained lost on the right L5 and S1 distributions. He continued to ambulate using a Lofstrand crutch.
  
  
  CONCLUSIONS
  Lateral lumbar fracture-dislocation at 2 noncontiguous levels is an unusual injury that results from high-energy trauma. Prompt recognition of the injuries, reduction of the fracture-dislocations, and posterior stabilization are recommended for neural decompression, spinal alignment, and long-term stabilization.
authors.affiliation: Neurosurgery staff, Department of Neurosurgery, Tsukazaki Hospital, Himeji, Japan.
authors.forename: Yaoki
authors.initials: Y
authors.lastname: Nakao
authors.affiliation: Orthopedic surgery director, Department of Orthopedic Surgery, Tonan Hospital, Sapporo, Japan.
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Kajino
keywords: Back injuries; Spinal fractures