Unusual Pattern of Traumatic Anterolisthesis at Multiple Levels (L3,4,5 Over S1) Because of Pedicle Avulsion

Abstract

Case: Multilevel lumbar spondylolistheses have been reported, but only secondary to degenerative processes. We describe a case where grade 4 anterolisthesis occurred (L3,4,5 over S1) because of multiple level traumatic pedicle avulsion rather than facetal/pars interarticularis/posterior ligamentous complex disruption in a 42-year-old man who presented with paraparesis after a fall from height. Decompression was performed at the L5 level, and pedicle screw fixation was performed at L3, L5, and S1 levels. Conclusion: Although such an injury pattern seems catastrophic, it is deemed relatively stable because of the intact posterior ligamentous complex. Restoration of anatomy with stabilization allowed early mobility and satisfactory neurological recovery.

Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review

“…Anterolistesis is associated with neurological deficits such as foot drop and other motor disorders of L5 [ 2 , 4 - 5 ]. In this case, the patient had no radiculopathy but presented with chronic backache.…”

“…The literature indicates that sagittal spinopelvic equilibrium plays a vital role in the development and progression of spondylolisthesis. The stability of the lumbar segment is determined by both clinical and radiological criteria [ 5 ]. High-grade spondylolisthesis defined as translation >50% is an uncommon cause of low back pain in adults which may sometimes present with radiculopathy.…”

“…High-grade spondylolisthesis is seen in 11.3% of patients with listhesis [ 6 ]. The clinical presentation will depend on the degree of displacement of the vertebra [ 5 , 7 - 8 ].…”