Acute traumatic L5-S1 spondylolisthesis: a case report

Anterior Traumatic Lumbosacral Dislocation: A Case Report

Traumatic dislocation of the lumbosacral joint is a rare and severe lesion usually caused by high-energy trauma. The literature on traumatic spondylolisthesis is limited, and most published papers are sporadic case reports. By presenting the case of an anterior traumatic L5-S1 spondylolisthesis without neurological deficits caused by a 6-meter fall, we discuss the anatomopathological mechanism of this injury, clinical and radiological evaluation, and current management options. The patient was treated surgically with a combined posterior instrumented reduction and transforaminal interbody fusion. At the final follow-up after seven years, the radiological evaluation showed an unchanged spondylolisthesis reduction with reliable fusion healing. In addition, the patient had good functional results and resumed recreational activities and work. Traumatic lumbosacral spondylolisthesis requires a careful and well-documented initial clinical and radiological assessment. Most authors advocate surgical treatment as the mainstay of management. However, the long-term prognosis remains unclear and unpredictable.

Clinical characteristic and surgical treatment of traumatic lumbar spondylolisthesis: A series of 28 patients

OBJECTIVE

To explore the clinical characteristics and the short-term efficacy of posterior operation for traumatic lumbar spondylolisthesis.

METHODS

All 28 patients (between January 2013 and June 2018) were treated with lumbar pedicle screw fixation combined with posterior intervertebral fusion. The clinical data and imaging materials of these patients were retrospectively analyzed.

RESULTS

The mean follow-up period was 24.3 months (12-36 months). The average VAS score and JOA score were significantly improved after surgery, and the difference was statistically significant (P<0.05).The last follow-up X-ray showed that 16 cases were degree 0 and 12 cases were degree I according to Meyerding grading, which were statistically improved compared with preoperative. Postoperative CT indicated lumbar internal fixation well, and the lumbar fusion rate was 100%. The Frankel grading of neurological function was significantly improved compared with preoperative.

CONCLUSION

Acute traumatic lumbar spondylolisthesis is caused by severe trauma and mostly occurred at L4/L5 and L5/S1 level. Early posterior reduction, decompression and intervertebral fusion can achieve satisfactory clinical and radiological outcome.

Delayed Treatment of a Traumatic Lumbosacral Dislocation With Associated Injuries: A Case Report

CASE

A 41-year-old woman sustained a degloving injury over her lumbosacral and perineal region with fractures of her right tibia and fibula. After diversion colostomy and osteosynthesis for the fractures at a primary center, a missed grade 2 lumbosacral dislocation was diagnosed at a tertiary center and the degloving injury was treated with debridement and skin grafting. After 5 months, the dislocation had progressed to grade 4 and she underwent delayed posterior lumbosacral reduction, interbody fusion, and L4-S1 fixation, with superior gluteal artery perforator flap and subsequent colostomy closure, with good outcomes (Oswestry Disability Index 10%) at the 3-year follow-up.

CONCLUSION

A rare, missed, progressive traumatic L5-S1 spondylolisthesis with associated injuries is described.

Traumatic Lumbar Spondylolisthesis: A Systematic Review and Case Series

STUDY DESIGN

Systematic review and case series.

OBJECTIVES

Any acute injury to the posterior elements of the lumbar spine resulting in listhesis is considered a traumatic spondylolisthesis. This rare injury caused by high-energy trauma is variably described in the literature as fracture-dislocation, where only case reports and series have been published. Our objectives were to propose evidence-based treatment recommendations and a new classification system for this injury.

METHODS

A systematic review of literature from PubMed, EMBASE, and Cochrane without time frame limitations was performed, which included 77 level IV and V articles and 9 patients as case series in the analysis.

RESULTS

A total of 125 cases were reviewed with mean age of 30.5 years. Half of the cases resulted from a vehicular accident. Back pain presented in 82%, while 50% had neurologic deficits. Operative treatment was performed in 93.6% (posterior decompression [PD] = 4%; posterior spinal fusion [PSF] = 43.2%; interbody fusion [IB] = 46.4%) with overall fusion rates of 74%. Binomial regression analysis for achieving solid fusion showed a 28.6× higher odds for IB compared to PSF (P = .008, r ² = 0.633). Subanalysis of cases with disc injuries revealed higher fusion outcomes for IB (87%) compared to PSF (46%; P = .006), while there were no significant differences for patients without disc injury. Pain and neurological symptoms improved significantly on final follow-up (P < .001). Overall complication rate was 22%.

CONCLUSION

Operative management with reduction, decompression for neurologic deficits, instrumentation, and fusion is recommended for traumatic spondylolisthesis. Interbody fusion is recommended to achieve better fusion outcomes especially with preoperatively identified disc lesions.

Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Traumatic lumbosacral dislocation is a rare, high-energy mechanism injury characterized by displacement of the fifth lumbar vertebra in relation to the sacrum. Due to the violent trauma typically associated with this lesion, there are often severe, coexisting injuries. High-quality radiographic studies, in addition to appropriate utilization of CT scan and MRI, are essential for proper evaluation and diagnosis. Although reports in the literature include nonoperative and operative management, most authors advocate for surgical treatment with open reduction and decompression with instrumentation and fusion. Despite advances in early diagnosis and management, this injury type is associated with significant morbidity and mortality, and long-term patient outcomes remain unclear.

Traumatic Lumbosacral Spondylolisthesis: A Case Report

INTRODUCTION

Traumatic lumbar spondylolisthesis is rare disease and in the literature, different surgical approaches, including anterior, posterior, or combined approaches (posterior and anterior) are used to treat the lesion.

CASE PRESENTATION

We treated a case of traumatic lumbosacral spondylolisthesis using posterior approach and the patient showed a satisfactory outcome. At the final follow-up, he was completely asymptomatic, and radiographic images revealed normal lumbar alignment and a solid interbody fusion.

CONCLUSIONS

Traumatic lumbosacral spondylolisthesis can be treated using posterior approach alone to obtain reduction, decompression, and solid fusion.

Traumatic Spondylopelvic Dissociation: A Report of Two Cases of Spondylolisthesis at L5-S1 and Review of Literature

Study Design Retrospective chart review and review of literature. Objective Few case reports of traumatic L5-S1 displacement have been presented in the literature. Here we present two cases of traumatic spondylolisthesis showing both anterior and posterior displacement, the treatment algorithm, and a review of the literature. Methods The authors conducted a retrospective review of representative patients and a literature review of traumatic spondylolisthesis at the L5-S1 junction. Two representative patients were identified with traumatic spondylolisthesis: one with an anterior dissociation, and the other with a posterior dissociation. Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes. Operative stabilization was necessary, and both patients were treated with open reduction internal fixation. The patient with posterior dissociation had complete recovery without neurologic sequelae. The patient with anterior dissociation had persistent bilateral L5-S1 radiculopathy with intact rectal tone, due to neurologic compression. Conclusions Few cases of traumatic spondylopelvic dissociation that are isolated to the L5-S1 disk space are described in the literature. We examined both an anterior and a posterior dissociation and treated both with L5-S1 posterior spinal fusion. The patient with anterior dissociation had persistent L5-S1 root injury; however, the patient with posterior dissociation had no neurologic deficits. This is the opposite of what is expected based on anatomy. These cases offer insight into the management of anterior and posterior L5-S1 spondylopelvic dissociation.

Treating Traumatic Lumbosacral Spondylolisthesis Using Posterior Lumbar Interbody Fusion with three years follow up

Objective: To analyze the surgical outcome of traumatic lumbosacral spondylolisthesis treated using posterior lumbar interbody fusion, and help spine surgeons to determine the treatment strategy.

Methods: We reviewed retrospectively five cases of traumatic lumbosacral spondylolisthesis treated in our hospital from May 2005 to May 2010. There were four male and one female patient, treated surgically using posterior lumbar interbody fusion. The patients’ data including age, neurological status, operation time, blood loss, follow-up periods, X- radiographs and fusion status were collected.

Results: All the cases were treated using posterior lumbar interbody fusion to realize decompression, reduction and fusion. Solid arthrodesis was found at the 12-month follow-up. No shift or breakage of the instrumentation was found, and all the patients were symptom-free at the last follow-up.

Conclusion: Traumatic lumbosacral spondylolisthesis can be treated using posterior lumbar interbody fusion to realize the perfect reduction, decompression, fixation and fusion.

Traumatic lumbar spondylolisthesis

Traumatic lumbar spondylolisthesis is a rare lesion and frequently noted in patients with multiple traumatic injuries. We report one case of L5 traumatic spondylolisthesis, which obtained successful decompression, reduction, interbody fusion and fixation by posterior lumbar interbody fusion, and got satisfactory outcome. We recommend early decompression, reduction, interbody fusion and fixation with posterior instrumentation to obtain the recovery of neurological function and stability of the spine.

Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: a case report

OBJECTIVE

Lumbar fracture-dislocations are rare and invariably due to high-energy trauma. The purpose of this study is to report the surgical management of a man with lateral lumbar dislocations in 2 noncontiguous lesions.

CLINICAL FEATURES

A 49-year-old Asian man was crushed by a bulldozer. The patient was transported to a major medical center where he was found to be conscious, and the primary spinal injuries were fracture-dislocation of L1-L2 and L4-L5. His preoperative neurologic status showed a partial paraparesis to all motor groups of the lower extremities bilaterally. His radiological and operative findings showed a rupture of the thoracolumbar fascia and latissimus dorsi muscle, left L1-L2 dislocated facet, right L4-5 facet fracture, and dural tear.

INTERVENTION AND OUTCOME

The patient underwent a posterior reduction, decompression, instrumentation, and fusion surgery from T12 to S1 with autologous bone graft and pedicle screw instrumentation. Postoperatively, his neurologic status improved, allowing him to be ambulatory using a Lofstrand crutch with improved lumbosacral alignment being well maintained. Two weeks postoperatively, the patient regained voluntary bowel and bladder function. At the 1-year follow-up evaluation, his motor power was full in the left leg; however, sensation to pin prick remained lost on the right L5 and S1 distributions. He continued to ambulate using a Lofstrand crutch.

CONCLUSION

Lateral lumbar fracture-dislocation at 2 noncontiguous levels is an unusual injury that results from high-energy trauma. Prompt recognition of the injuries, reduction of the fracture-dislocations, and posterior stabilization are recommended for neural decompression, spinal alignment, and long-term stabilization.

Traumatic L5-S1 spondylolisthesis in a 15-year-old: a case report

Traumatic spondylolisthesis is a rare injury resulting from complex trauma and high-energy mechanisms. We present a case report of traumatic spondylolisthesis at the L5-S1 disc space of a patient who was buried after a wall fell on his back. In the physical examination, bilaterally decreased muscle strength was observed. Examination images indicated a 90% slip at L5-S1. Surgical treatment was provided with a posterior and anterior approach using pedicle fixation and an anterior cage. After 4 months, there was significant recovery of muscle strength in the lower limbs.

Unilateral lumbosacral dislocation: case report and a comprehensive review

Lumbosacral fracture-dislocation is a rare occurrence. There are more than 73 cases reported in the English literature. We report on the imaging findings and surgical treatment in a patient suffered of unilateral traumatic L5-S1 dislocation associated with severe disruption of the posterior ligamentous complex. The patient underwent open reduction and stabilization of L4-S1 vertebrae with posterior instrumentation system. Open reduction and internal fixation was mandatory as post-traumatic ligamentous insufficiency would lead to abnormal motion. Operative treatment managed to produce a solid arthrodesis and restore stability of the lumbosacral junction. Follow-up revealed excellent results. This study reports a rare injury of the lumbosacral junction, and the literature concerning this unusual condition is extensively reviewed.

Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report

STUDY DESIGN

A case report.

OBJECTIVE

To describe a case of traumatic lumbosacral spondyloptosis and present a literature review.

SUMMARY OF BACKGROUND DATA

Traumatic spondyloptosis is a very rare injury caused by high-energy trauma. Eight cases of traumatic spondyloptosis of L5-S1 have been reported, including only 1 case treated 8.5 months after injury occurrence.

METHODS

A 45-year-old Myanmar male experienced severe lower back pain and paresis of the lower extremities after a landslide disaster. Plain radiographs showed spondyloptosis, with the 5th lumbar vertebra located anterior to the 1st sacral vertebra. Computed tomography myelography demonstrated complete bilateral pars interarticularis fracture dislocation at L5-S1 and a complete block between L5 and S1 with apparent spondyloptosis. Neurological function of this patient improved after conservative treatment for 5 months; however, his severe lower back pain persisted. Thus, surgery for in situ posterior decompression and fusion of L3-S1 was performed.

RESULTS

Lower back pain of the patient had nearly disappeared 2 weeks after surgery, and he was able to walk for more than 1 hour without assistance 2 years after surgery.

CONCLUSION

We performed posterior decompression and in situ fusion of L3-S1 for the patients with traumatic lumbosacral spondyloptosis treated 5 months after injury, and the surgery produced a favorable clinical outcome.

Traumatic spondyloptosis of L4

STUDY DESIGN

Case report of 2 patients with traumatic L4-L5 spondyloptosis.

OBJECTIVE

To report the diagnosis and treatment of the traumatic L4-L5 spondyloptosis.

SUMMARY OF BACKGROUND DATA

Traumatic L4-L5 spondylolisthesis is even rarer than traumatic L5-S1 spondylolisthesis. No case of traumatic L4-L5 spondyloptosis (anterolisthesis of Grade V) has been reported. The injury mechanism and surgery management merit more studies.

METHODS

Through the posterior approach, both of the 2 patients underwent the decompression and reduction with pedicle screws. One had the posterolateral fusion and the interbody fusion from L4-L5 whereas the other had the posterolateral fusion from L4-S1.

RESULTS

Complete reduction and fusion were achieved. The neurologic symptoms improved after the surgery. At follow-ups of 1 year and 6.5 years, there was no further slippage of the vertebrae. They were satisfied with the treatment outcomes.

CONCLUSION

Posterior decompression, reduction, internal fixation, and fusion is effective and dependable for traumatic L4-L5 spondyloptosis.

Lumbosacral dislocation: a review of the literature and current aspects of management

Lumbosacral fracture dislocation is a very rare lesion and was first described by Watson-Jones in 1940. Two anatomical classifications are described in the literature, all other reports are case presentations. This fracture type is characterised by an antero- or retrolisthesis or a lateral translation of the 5th lumbar vertebra in relation to the sacrum. Biomechanics are discussed controversially. Most patients suffer from a high energy trauma with concomitant severe injuries. There is a high rate of additional neurological deficits. Fractures of the transverse process are thought to be sentinel fractures. MRI and CT scans are essential to detect the whole extent of the lesion. Circumferential fusion is recommended by several authors to regain stability at the lumbosacral junction.

Traumatic spondylolisthesis of the lumbar spine: a report of three cases

Traumatic spondylolisthesis of the lumbar spine is uncommon and can result in canal narrowing and spinal cord injury. Early decompression promotes recovery of neurological function. We report 3 such cases: one in the lumbosacral joint and 2 in the lumbar spine. The former patient had an open fracture-dislocation and underwent (delayed) posterior decompression and instrumentation without interbody fusion. The connecting rods broke at 3 years and the patient had a residual neurological deficit. We recommend early decompression with posterior instrumentation and interbody fusion for maximum recovery of neurological function and stability of the spine.

Traumatic L4-L5 spondylolisthesis: case report

We report a case of L4-L5 traumatic anterolisthesis. The patient was treated surgically 4 months after the injury. His radiological and operative findings showed L4 inferior facet tip fracture, L4-L5 anterior displacement and left L4-L5 foraminal disc protrusion. Decompression, reduction with L3, L4, L5 pedicular screw fixation, L4-L5 disc excision and interbody cage insertion with autologous bone grafts were done. Flexion type injury was thought to be the probable mechanism.