Acute traumatic L5–S1 spondylolisthesis: a case report

Study Design: Case report of a patient treated surgically 2 months after sustaining a misdiagnosed acute traumatic lumbosacral dislocation is presented. Objectives: The aims is to report in full about an uncommon case of anterior traumatic L5–S1 spondylolisthesis treated successfully with combined posterior stabilization and anterior fusion. Summary of background data: Review of literature shows that traumatic lumbosacral dislocations and its treatment by open reduction and internal fixation are rare with only few well-documented case reports. Methods: We report the case of a 37-year-old man, who sustained a work-related traumatic lumbosacral dislocation. The delayed diagnosis of traumatic L5–S1 spondylolisthesis was initially missed and first treated, when the patient was transferred to the author’s institution because of persistent neurological deficits. In the following the patient was successfully reduced and stabilized with posterior internal fixation and anterior interbody fusion. This case is documented in detail with radiographs, CT and MRI scans, as well as clinical pictures. Results: At a 1.5-year follow-up complete fusion was achieved. The patient returned to work on the same job before injury, ambulating pain-free with a good subjective back-function and no limitations carrying out his recreational activities. At follow-up he had persistent sensible S1 nerve root deficits (ASIA grade E). Conclusions: Traumatic lumbosacral spondylolisthesis is a rare injury pattern. Its diagnosis can be missed initially, therefore computed tomography with biplanar reconstructions is mandatory in addition to good-quality conventional radiographs to plan and carry out such challenging management problems successfully. Surgical treatment for reduction, stabilization and interbody fusion is the method of choice.