Pure traumatic lumbosacral dislocation without facet fracture: A case report and review of the literature

Background: Pure traumatic lumbosacral dislocation without facet fracture is an exceptionally rare injury resulting from high-energy trauma. Because neurological deficits may be absent, diagnosis can be delayed. Early recognition and surgical stabilization are essential to prevent secondary instability and progressive neurological deterioration. Case Description: A 54-year-old male was admitted after a high-speed motor vehicle accident with severe low back pain but remained neurologically intact. The initial computed tomography (CT) demonstrated bilateral L5–S1 facet dislocation without associated fracture and Meyerding grade I anterolisthesis. Notably, CT performed 48 h later showed progression to Meyerding grade II anterolisthesis, and magnetic resonance imaging (MRI) confirmed complete disruption of the L5–S1 intervertebral disc and posterior ligamentous complex. The patient underwent posterior reduction requiring bilateral facetectomy, followed by pedicle screw fixation and L5–S1 interbody fusion. Eighty days postoperatively, the patient remained neurologically intact. Conclusion: Pure lumbosacral dislocation without facet fracture is a rare but highly unstable injury. Combined CT and MRI are essential for establishing the diagnosis and assessing instability, which may prompt early surgical reduction and stabilization to prevent secondary displacement and neurological deterioration.