What is the most likely diagnosis?
A 20-year old male presents with low back pain following a fall onto a concrete floor. The patient gives a history of episodic aching of the lumbar region prior to the fall. Examination of the patient in the prone position reveals a deep sulcus on the left, a posterior/inferior ILA on the right when compared to the opposite side, and a lumbosacral junction that springs freely upon compression. Â
A. A forward sacral torsion on a right oblique axis B. A forward sacral torsion on a left oblique axis C. A backward sacral torsion on a left oblique axis D. A left unilateral sacral flexion E. Bilateral sacral extension
In a patient with a deep left sulcus and a negative lumbosacral spring test, the left portion of the sacrum has moved anterior. Since the above patient has posterior/inferior ILA on the right this indicates that this portion of the sacrum has moved posteriorly. A forward sacral torsion on a right oblique axis (i.e. a right rotation on a right oblique axis) is the only answer that would be consistent with the above findings.