Traumatic Spondylolisthesis of the Fourth Lumbar Vertebra Without Neurologic Deficit or Fracture of the Posterior Elements

Case Reports

. 2021 Feb 9;13(2):e13238.


doi: 10.7759/cureus.13238.

Affiliations

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Case Reports

Ioannis Papaioannou et al.


Cureus.


.

Abstract

Acute traumatic spondylolisthesis in the lumbosacral spine is an uncommon injury. Traumatic dislocation of the fourth lumbar vertebra over the fifth lumbar vertebra (L4/L5) is extremely rare since few studies have been reported in the current literature. We report on a 53-year-old man, who had a motor vehicle accident and sustained an injury of the lumbar spine without neurological impairment. The radiographic evaluation disclosed an L4/L5 traumatic spondylolisthesis, classified as Meyerding grade III without any fracture of the posterior vertebral elements. To the best of our knowledge, this is the sixth case of L4 traumatic spondylolisthesis without concomitant fracture of the posterior vertebral elements and the third case without any neurological deficit among them. The patient underwent open reduction and posterior instrumentation. Intraoperatively, the posterior ligamentous complex, the capsules of the facet joints and also the disc were found torn, although facets, neural arch, and pedicles were intact. Following decompression and reduction of the spondylolisthesis without any neurologic complications, we performed pedicle screws and rods fixation from the third to the fifth lumbar vertebra (L3-L5). The patient had an uneventful recovery and returned to his previous activity three months after surgery. The four-year follow-up evaluation showed normal spinal alignment, successful pain-free fusion without neurologic complications. Flexion/distraction injury without simultaneous rotation at the L4/L5 segment during traffic accidents or the fall of a heavy object on the bent back accompanied with posterior ligament weakness is thought to be the probable mechanism for this type of injury. Concomitant neurologic impairment is associated with the majority of L4/L5 spondylolisthesis cases. Posterior decompression, reduction, and posterior instrumentation enhances bony fusion, improves the patient’s neurologic status and restores the sagittal alignment.


Keywords:

flexion/distraction injury; ligamentous rupture; pedicle screw fixation; traumatic lumbar spondylolisthesis.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures


Figure 1


Figure 1. Preoperative supine lateral roentgenogram on admission of the lumbar spine showing Meyerding III anterolisthesis of L4. The black arrow shows the avulsion fracture of the anterior–superior vertebral corner.


Figure 2


Figure 2. Preoperative anteroposterior roentgenogram of the lumbar spine showing narrowing of the intervertebral space (black arrows).


Figure 3


Figure 3. Preoperative lateral supine CT scan with sagittal reconstruction showing the anterolisthesis of L4 and the avulsion L5 fracture (black arrow).


Figure 4


Figure 4. Preoperative axial CT scan at the segment L4-L5 showing double contour (white arrow), indication of olisthesis.


Figure 5


Figure 5. Postoperative (three months follow-up) standing roentgenogram of the lumbar spine showing excellent sagittal balance and pedicle screw-rod fixation in situ.


Figure 6


Figure 6. Postoperative (three months follow up) standing anteroposterior roentgenogram of the lumbar spine. The black arrows show the level of the interbody fusion.


Figure 7


Figure 7. Postoperative lateral standing roentgenogram of the lumbar spine four years postoperatively. Note the completed fusion (white arrow) and excellent sagittal balance.


Figure 8


Figure 8. Postoperative anteroposterior standing lateral roentgenogram of the lumbar spine in the last evaluation, four years postoperatively.

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