Management of distraction injury of the lumbosacral junction with unilateral perched facet

BACKGROUND: Traumatic unilateral facet dislocation without fracture is an uncommon injury of the lumbosacral junction. We describe a case of a unilateral perched L5–S1 facet causing axial back pain and radiculopathy provoked by motion. CASE DESCRIPTION: The patient underwent reduction with complete facetectomy followed by internal fixation at L5–S1, facilitating decompression of the S1 nerve root. Postoperatively, the patient reported improvement in her pain. CONCLUSIONS: This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements. Despite its rarity, when identified, this injury can be characterized using the new TLICS system for thoracolumbar fractures and should be managed accordingly.