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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 .
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 .
traumatic lumbosacral spondylolisthesis can be treated using posterior approach alone to obtain reduction , decompression , and solid fusion .
traumatic lumbosacral spondylolisthesis is a rare injury ( 1 - 3 ) ; most of the cases were published as case reports in the literature . the injury results from a complex and high - energy mechanism ( 4 ) or forces , including hyperextension stress ; hyperflexion and compression stress ; or tangential force ( 5 ) .
most surgeons believe that the injury should be treated surgically , and in this regard different surgical approaches are used in spine departments .
we report a case of traumatic lumbar spondylolisthesis , which was treated using posterior approach to realize the stable 3-column fixation and solid interbody fusion .
a 38-year - old man was referred to the affiliated hospital of jinan university , guangzhou , china due to injury in a motorcycle accident on july 25 , 2011 .
he was conscious with stable vital signs , but complained of pain in his back and right thigh , numbness and weakness in both lower extremities . upon physical examination ,
grade 4 power was found in both lower limbs , and the perianal sensation and anal tone were normal too .
x - radiographs showed a grade 2 spondylolisthesis of l5 on s1 ( figure 1 ) , fracture of the left transverse process of l4 as well as the fracture of right femur .
mri demonstrated traumatic lumbar spondylolisthesis of l5 on s1 , avulsion of the l5 intervertebral disc and compression of the cauda equina ( figure 1 ) .
first , open reduction and internal fixation were performed for the fracture of right femur , and then a posterior approach surgery was performed for the traumatic lumbosacral spondylolisthesis using a standard posterior midline incision . during operation ,
bilateral fracture of the pars interarticularis , disruption of interspinal ligament and flaval ligaments of l5-s1 , and disruption of l5 annulus fibrosus were found .
decompression and reduction were done followed by internal fixation using pedicle screws and rods from l4 to s1 .
posterolateral fusion was performed at l4 - 5 level ; l5 disk was excised and 2 peek cages were inserted posteriorly with autologous bone grafts .
the procedure lasted 145 minutes with intraoperative blood loss of 400 ml , without intraoperative complications .
four weeks later , his strength and cutaneous sensation in both lower extremities recovered completely .
one and a half year after surgery , at the final follow - up , the patient was completely asymptomatic and radiographs revealed normal lumbar alignment and a solid interbody fusion ( figure 2 ) .
in addition , the fracture of right femur obtained bony union and he could stand and walk without any support , and resumed his previous level of physical activities .
in the english literature , some cases of traumatic spondylolisthesis were reported , which were treated successfully using conservative methods ( 7 , 8) , but the non - surgical treatment may result in posttraumatic translational instability or chronic low back pain ( 1 , 3 ) .
moreover , the rare lesion belonged to a 3-column injury ( 9 ) and need a solid internal fixation . as a result ,
surgical treatment was a better choice for the injury ( 1 - 3 , 9 ) . in the literature , this kind of injury was treated using different surgical approaches , including anterior ( 10 ) , posterior ( 1 , 2 , 9 ) , or combined approach ( anterior and posterior ) ( 11 , 12 ) , but there is not a decisive criterion to determine which surgical approach to select . in this case , the lesion included a traumatic disruption of the intervertebral disk material , dislocation of l5 vertebral body and bilateral fracture of the pars interarticularis .
therefore , excision of intervertebral disc and reduction of l5 vertebral body as well as interbody fusion were needed ( 1 ) .
in addition , decompression and internal fixation to avoid further injury to the nerve system , stabilize the spine , and promote the recovery of the nerve system was necessary .
compared with anterior or combined approach , the posterior approach is safe , easy , and with minimum complication . moreover
, the pedicle - rod system can result in perfect reduction of vertebral body and 3-column fixation .
consequently , decompression , fixation , and interbody fusion can be achieved using posterior approach alone . at the same time
, the higher risk of blood loss , longer hospital stay and the high cost which is associated with anterior or combined approach can be avoided or decreased . in the present case ,
this kind of case is rare , and it is difficult to compare different surgical approaches using a large scale , or a clinical controlled trial , but we believe the posterior approach alone may be an optimal selection for this rare injury .
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 .