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

Abstract

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.

Combined Posterior-Anterior Interbody Fusion in the Management of Traumatic Lumbosacral Dissociation: A Case Report and Review of Literature

“…TLSD requires the stabilization of concomitant injuries and patient-specific evaluation of spinal dissociation severity. Due to the complete osseoligamentous complex disruption, surgical stabilization with possible decompression is almost universally required, unless patients are critically injured and unlikely to survive their injury [4][5]16]. The most common approaches used involve anterior lumbar inter-body fusion (ALIF), a posterior lumbar interbody fusion (PLIF), a combined approach using PLIF and transforaminal lumbar interbody fusion (TLIF), circumferential lumbar fusion (CF), or newer and increasingly more popular minimally invasive techniques.…”

“…Current literature on classification and treatment algorithms for high-energy lumbosacral dissociations and fractures is suboptimal, as they are primarily descriptive and lack prognostic value [2]. However, there is a consensus that treatment ordinarily involves surgical decompression and there are several techniques to choose from, which are based on published studies that provide low levels of evidence (level IV) [4][5]16]. Lehman et al provided a novel classification system consisting of thresholds classifying surgical and nonsurgical candidates, determining the optimum operative technique by generating a composite injury severity score based on a weighted score from categories such as injury morphology, posterior ligamentous complex integrity, and neurological status [2].…”

Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

“…The direction of dislocation may vary depending on the traumatic force vector, and includes anterior, anterolateral, lateral, and posterior dislocations. Anterior dislocations, resulting in L5 anterior to S1, are most common [ 3 , 23 ], while posterior dislocations are typically associated with more severe neurological injuries [ 3 , 28 – 31 ].…”

“…There is some discrepancy in the literature with regard to the terminology describing injuries in this region; traumatic L5-S1 spondylolisthesis [ 3 – 7 ], lumbosacral/lumbopelvic dissociation [ 8 – 12 ], suicide jumper's fracture [ 13 ], spinopelvic dissociation [ 14 – 17 ], and spondylopelvic dissociation [ 18 – 20 ] have all been used to describe a spectrum of similar injuries. The terms spinopelvic and spondylopelvic dissociation are generally reserved for a more severe injury pattern with U-type, H-type, II-type, Y-type, or lambda type sacral fractures in conjunction with bilateral sacral fracture dislocations [ 17 ].…”

Expert’s comment concerning Grand Rounds case entitled “Floating lumbar spine: proposed mechanism with review of literature” (K. Das et al., Eur Spine J. doi:10.1007/s00586-016-4690-2)

“…Traumatic spondylolisthesis has consistently been linked to high-energy trauma despite the lack of agreement in the literature on the mechanism (i.e., forced hyper-extension, forced hyper-flexion with compression, or horizontal shear combined with rotation) [2][3][4][5]. Although a rare injury, a high index of suspicion and early investigation remains a cornerstone in the diagnosis.…”