Minimally Invasive Surgery for Traumatic High-Grade Lateral Spondylolisthesis of L1 with Multiple Spinal Fractures: Closed Reduction and Internal Fixation Using Percutaneous Pedicle Screws.

Abstract

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.