Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 692-694
DOI: 10.4103/ajns.AJNS_63_21
Original Article

Minimally invasive surgery for traumatic high-grade lateral spondylolisthesis of L1 with multiple spinal fractures: Closed reduction and internal fixation using percutaneous pedicle screws

Takeshi Sasagawa
Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Background: Traumatic high grade lateral spondylolisthesis at the thoracolumbar junction is an extremely severe injury caused by high-energy trauma, commonly resulting in polytrauma. The treatment of this pathology is challenging, and even death following surgery has been reported. Therefore, it is necessary to focus on making surgical invasion minimal. Methods: A 53-year-old female fell from a height and presented with severe back pain and complete paralysis below L1. Computed tomography (CT) showed a Grade 4 traumatic lateral spondylolisthesis and severe comminution of L1, and mild compression fractures at T9 and L3. Results: First, we performed posterior surgery on the day of the injury to reduce the fracture and stabilize the spinal column using percutaneous pedicle screws (PPS). Twelve days later we resected the L1 vertebral body and inserted a cage with an iliac bone graft using an anterior approach. The estimated blood loss from posterior and anterior surgeries was 320ml and 200ml, respectively. Bony fusion was achieved as seen on CT at the 1-year follow-up. Conclusion: A 2-stage combined posterior-anterior approach using PPS can be performed less invasively, enabling adequate reduction, internal fixation, and anterior reconstruction for patients with high grade traumatic lateral spondylolisthesis without spinal shortening or facet interlocking.

Key-words:

Combined posterior–anterior approach - lateral spondylolisthesis - minimally invasive surgery - percutaneous pedicle screws - thoracolumbar fracture

Financial support and sponsorship

Nil.




Publication History

Received: 12 March 2021

Accepted: 04 May 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Garg M, Kumar A, Sawarkar DP, Singh PK, Agarwal D, Kale SS, et al. Traumatic lateral spondyloptosis: Case series. World Neurosurg 2018;113:e166-71.
  • 2 Mishra A, Agrawal D, Gupta D, Sinha S, Satyarthee GD, Singh PK. Traumatic spondyloptosis: A series of 20 patients. J Neurosurg Spine 2015;22:647-52.
  • 3 Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976) 2004;29:803-14.
  • 4 Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Arce CA, Nguyen TQ, et al. The effect of early surgical treatment of traumatic spine injuries on patient mortality. J Trauma 2007;63:1308-13.
  • 5 Sun XY, Zhang XN, Hai Y. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: A meta-analysis. Eur Spine J 2017;26:1418-31.
  • 6 Howard BM, Holland CM, Krieger DA, Ahmad FU. Open reduction and posterior instrumented spinopelvic fixation for traumatic grade IV lateral spondylolisthesis of the thoracolumbar spine. Spine J 2015;15:1700-1.
  • 7 Haddadi K, Hosseini SM, Khadem A, Hashemian MB. One-stage posterior only corpectomy and fusion in the treatment of a unique acute low lumbar l4 burst fracture without neurologic deficit: A case presentation. Asian J Neurosurg 2020;15:691-4.
  • 8 Yadla S, Lebude B, Tender GC, Sharan AD, Harrop JS, Hilibrand AS, et al. Traumatic spondyloptosis of the thoracolumbar spine. J Neurosurg Spine 2008;9:145-51.
  • 9 Reddy SJ, Al-Holou WN, Leveque JC, La Marca F, Park P. Traumatic lateral spondylolisthesis of the lumbar spine with a unilateral locked facet: Description of an unusual injury, probable mechanism, and management. J Neurosurg Spine 2008;9:576-80.
  • 10 Stahel PF, Flierl MA, Moore EE, Smith WR, Beauchamp KM, Dwyer A. Advocating “spine damage control” as a safe and effective treatment modality for unstable thoracolumbar fractures in polytrauma patients: A hypothesis. J Trauma Manag Outcomes 2009;3:6.
  • 11 McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976) 1994;19:1741-4.