A spondylolisthesis also is graded according to the amount that one vertebral body has slipped forward on another. A grade I slip means that the upper vertebra has slipped forward less than 25 percent of the total width of the vertebral body, a grade II slip is between 25 and 50 percent, a grade III slip between 50 and 75 percent, a grade IV slip is more than 75 percent, and in the case of a grade V slip, the upper vertebral body has slid all the way forward off the front of the lower vertebral body, a condition called spondyloptosis.
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.
If a relationship is established between the spondylolysis and the symptoms, treatment may vary from rest from the aggravating activity, to gentle mobilisation of spine (always being aware that increasing range of motion may be contraindicated in this type of pathology), to braces/corsets, to exercises - particularly exercises, which aim to provide support to the lumbar spine and control the lordosis.
1. Junghanns H. Spondylolisthesen ohne spalt im Zwishengelenkstuck. Arch Orthop Unfall-Chir 1930;29:118-27.
2. Newman PH. Spondylolisthesis, its cause and effect. Ann R Coll Surg Engl 1955;16(5):305-23.
3. Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res 1976;(117):23-9.
4. Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. Spine (Phila Pa 1976) 1993;18(1):80-91.
5. Cinotti G, Postacchini F, Fassari F, Urso S. Predisposing factors in degenerative spondylolisthesis. A radiographic and CT study. Int Orthop 1997;21(5):337-42.
6. Fitzgerald JA, Newman PH. Degenerative spondylolisthesis. J Bone Joint Surg Br 1976;58(2):184-92.
7. Rosenberg NJ. Degenerative spondylolisthesis. Predisposing factors. J Bone Joint Surg Am 1975;57(4):467-74.
8. Gardocki RJ, Camillo FX. Other disorders of the spine. Campbell’s Operative Orthopaedics.12thed, Vol.2. Ch. 44. Philadelphia, PA: Elsevier Mosby: 2013. p. 2006-9.
9. Metz LN, Deviren V. Low-grade spondylolisthesis. Neurosurg Clin N Am 2007;18(2):237-48.
10. Mahato NK. Morphological traits in sacra associated with complete and partial lumbarization of first sacral segment. Spine J 2010;10(10):910-5.
11. Rodriguez-Fuentes AE. Traumatic sacrolisthesis S1-S2. Report of a case. Spine (Phila Pa 1976) 1993;18(6):768-71.
Traumatic spondylolisthesis is an uncommon entity reported in the literature. Watson-Jones described the first case in 1940 and about hundred cases reported since then . All reported cases are traumatic lumbosacral dislocations, which represents a dislocation on L5–S1 level.
There are few reports on traumatic spondylolisthesis  but probably none on DS. Further case series or longitudinal studies of such cases may help understand better the pathomechanics related to spondylolisthesis at this level.
Most authors tend to treat the type of trauma by surgery, which can be performed using anterior, posterior or anterioposterior approach. It is essential to restore normal lumbar alignment, decompress the nerve structures and stabilize the lumbar spine, using open reduction and rigid fixation. In addition, clear evidence of disc disruption can be found on preoperative MRI in our case, so we treated the case using posterior lumbar interbody fusion and the case obtained acceptable reduction and stabilization.
The mechanism of traumatic lumbar spondylolisthesis is complex and controversial. Some authors supported that hyperextension stress, hyperflexion and compression stress, or tangential force may be responsible for the occurrence of the trauma. It is challenging to propose an exact mechanism when the injury is complicated and severe. In our opinion, as the case had fracture of facet joints, the vectors of compression or axial translation may be the cause of the injury. Subsequently, we suggest the main factor is combination of tangential force and compression force.
A 44-year-old man was the driver of a tractor that has crashed to a tree and he was thrown to the ground. He was taken to a hospital and was diagnosed as traumatic spondylolisthesis of L4–L5 (Figs. , ). He was then treated conservatively in another hospital for 4 months, as he did not want to be operated. The first 25 days was an absolute bed rest and then he was mobilized with a soft lumbosacral corset.
Traumatic lumbar spondylolisthesis is uncommon lesion usually secondary to violent trauma. Among these injuries there were characteristic concomitant transverse processes fracture- of adjacent segments and according to the points of Herron and Roche PH the presence of transverse process fracture must result in the suspicion of associated traumatic lesions of the lumbosacral joint. Our case also suffered from fractures of transverse processes, which support the above viewpoint. However, the transverse process fracture is not the necessary sign associated with this kind of injury.,
The spondylolisthetic slip is defined as grades 1 - 4, with grade 1 being defined as a displacement forward by 1/4 of the antero-posterior diameter, grade 2 as 2/4 (or 1/2), grade 3 as 3/4 and grade 4 as 4/4, or full anterior displacement.
Five types of spondylolisthesis are reported in literatures including dysplastic, isthmic, degenerative, traumatic and pathologic spondylolisthesis. Traumatic spondylolisthesis is usually accompanied by a fracture of the posterior elements, which result in instability and listhesis.
Additional preoperative computed tomography, plain radiography and magnetic resonance images showed L4 inferior facet tip fracture and dislocation, grade 2 L4–L5 spondylolisthesis and left L4–L5 foraminal disc herniation (Figs. , , ) On neurological examination, hipoactivity of both Aschiles reflexes was found. He underwent surgery for L4–L5 dislocation. At operation bilateral facet dislocation and fractured tip of inferior L4 facets were confirmed. Decompression, including disc excision and open reduction, posterolateral fusion with autologous bone grafts taken from posterior iliac crest were done followed by internal fixation from L3–L5 vertebrae, using six pedicular screws and two rods. L4–L5 interbody cage was also inserted, with autologous corticocancellous bone grafts from the decompression material, in order to perform high degree of stability and fusion rate (Figs. , ). The patient was mobilized on the second postoperative day without any neurological symptoms and discharged on the third day. Three months after surgery, he was symptom free.