Management of traumatic sacral spondyloptosis: illustrative case

Abstract

BACKGROUND Grade V spondylolisthesis, or spondyloptosis, is a complication of high-energy trauma that is most commonly reported at the lumbosacral junction. Sacral intersegmental spondyloptosis is extremely rare. The authors present a case of spondyloptosis of S1 on S2 with a comminuted fracture of S2 and complex fractures of the L4 and L5 transverse processes, resulting in severe stenosis of the lumbosacral nerve roots. OBSERVATIONS The patient was a 70-year-old woman with a history of a fall 3 weeks prior and progressive L5 and S1 radiculopathy. Instrumentation and fusion were undertaken, extending from L3 to the pelvis because degenerative stenosis at L3–4 and L4–5 was also found. Reduction was achieved, leading to diminished pain and partial resolution of weakness. LESSONS Traumatic sacral spondyloptosis adds a degree of difficulty to reduction, fixation, and fusion. The technique presented herein achieved sagittal realignment via a distraction maneuver of S1–2 in which rods were attached to bilateral dual S2 alar-iliac screws with reduction screws placed at S1, ultimately pulling L5 and S1 up to the rod for fixation.

Case report: Traumatic lumbosacral spondyloptosis with locked L5 inferior articular process

“…In 2016, Adelved et al ( 16 ) reported that the rate of neurologic deficits corresponding to L5 and sacral roots in patients with lumbosacral dislocation was 84.6% (11/13). Some reports suggested that the time of decompression, the grade of slip, and the degree of neurologic deficits before operation are the main factors affecting the recovery of neurologic function ( 2 , 4 , 17 ).…”