Total Dislocation of Third and Fourth Lumbar Vertebrae - A Rare Case Report and Review Literature

AIM - Introduction: Dislocations of the mid-lumbar vertebrae are exceptional , very rare and results in unstable spine deformity and deformation, which lead to severe spinal cord injury and mortality . Only 16 cases found in the literature, All previously reported cases were treated surgically. We report a case of a male 45-year-old presented to our emergency department with complete dislocation of L3-L4 vertebrae , with neurological deficit . following injury back resulting from crash of motor lifting tripod falling heavy object on back of patient. The patient developed severe back pain and spinal deformity, and acute neurologic deficit both lower limbs with bowel bladder paralysis . Radiological examinations show complete anterior dislocation of L3 over L4. He also had injury right thigh leading to long spiral fracture of femur at subtrochanteric level . . Treatment: After initial assessment of trauma & patient care , initial surgery for fixation of femur was done. The anatomico pathological mechanism of injury is discussed, together with treatment, successful open reduction and stabilization by fixation long construct of pedicle instrumentation and spinal fusion . Outcomes: Postoperative digital radiography showed the correction of the spinal deformity with restoration of lumbar curve. The patient was pain-free and fully rehabilitated 6 months after the surgery. His neurological status improved from grade 0-1 to grade 2-3 with sphincter recovery. At the 1-year follow-up, the patient had pain free back with stable normal alignment. This helped in neurological recovery and was rehabilitated with assisted caliper walking.& good sphincter control. Conclusions: We report a case of L3 to L4 traumatic spondyloptosis that involved complete neural damage. Restoring stability and preventing secondary cord injury should be taken into consideration for better rehabilitation & neurological recovery.