Traumatic L1-L2 dislocation without fracture in a 6-year-old girl. Incomplete neurologic deficit and total recovery.

STUDY

DESIGN

A report of a rare complete dislocation of the first lumbar vertebra without fracture in a 6-year-old girl.

OBJECTIVES

To describe a rare traumatic lesion in children.

SUMMARY OF BACKGROUND DATA: Although there has been a report of posterior dislocations of vertebra without fracture accompanied by anterior apophyseal splitting in young cadavers, all in the cervical region, to date, there has not been a reported clinical case of vertebral dislocation in the thoracolumbar region in a child.

METHODS

A 6-year-old girl, while playing on a farm, had her hair caught in the wheel of a sugar beet harvesting machine. She was referred with incomplete paraplegia. Radiologic examination showed an L1-L2 dislocation with no fracture. She was treated surgically using a modified Luque frame with sublaminar wires.

RESULTS

Six months after injury, the patient had no neurologic deficit and was living an entirely normal life. Radiographs showed a perfect alignment of the thoracolumbar spine. At the 26-month follow-up, no radiologic abnormalities were observed, other than minimal end-plate sclerosis. Magnetic resonance images obtained after the removal of the implants showed no structural abnormalities in the vertebral column except disc narrowing at all instrumented levels, secondary to posterior fusion.

CONCLUSION

To date, this is the first case of dislocation of the thoracolumbar spine in children. It is further notable because the neurologic deficit was incomplete, although there were striking radiologic abnormalities.