Traumatic bilateral L4-5 facet fracture dislocation: a case presentation with mechanism of injury

BACKGROUND: Traumatic bilateral locked facet joints at L4–5 level are a rare entity. A careful review only revealed four case reports. This case presented with an unusual mechanism of injury. CASE PRESENTATION: We present a case of a 40-year-old male who suffered bilateral L4–5 traumatic facet fracture dislocation following a fall injury. The dislocation was associated with fractures of bilateral L4 inferior articular processes, left L4 pedicle, L4 spinous process and postero-inferior body of L4. He presented with cauda-equina syndrome and underwent emergency decompression, reduction and instrumented fusion. CONCLUSION: The biomechanics of the lumbar spine may differ with each individual. L4–5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury.