Traumatic spondylolisthesis is an uncommon injury and an unusual type of spondylolisthesis. It involves fracturing the posterior supporting elements, usually of the lumbar spine, following a trauma, which can be a fall, a striking injury, or an automobile accident.
When the supporting elements of the spine fracture, there is a forward or backward movement of the top vertebra over the vertebra beneath it, resulting in narrowing of the spinal canal and pressure on the spinal column. Fortunately, if there is early decompression of the spinal cord, some patients can recover function over time.
How Does Spondylolisthesis Occur?
Spondylolisthesis can happen in a seat-belted person who has a forward momentum of the spine above the level of the seat belt. This can cause forward movement of one vertebral body over another and compression and possible severing of the spinal cord at the level of the spondylolisthesis. Fast speeds and seatbelts that are only lap belts contribute to getting this type of injury.
Doctors can manage this injury in several ways. The most recommended approach is to decompress the spinal cord as soon as possible and, using posterior instrumentation, the doctor can achieve inter-vertebral body fusion so that the joint can heal and become stable again. The posterior elements are the fractured parts of the spine and involve the spinous processes and the transverse processes of the spinal vertebrae. Because of the flexibility of the spine in the lumbar and lumbosacral areas, these are the areas that most lead to spinal injury.
While some cases of traumatic spondylolisthesis are treated conservatively, others believe that the aggressive use of decompression and fusion of the vertebrae provide the safest and best outcome. Unfortunately, there are few cases of traumatic spondylolisthesis, so there are few studies available comparing the various treatments for the disease.
Study on Spondylolisthesis
In one study of three patients who sustained spondylolisthesis due to trauma, it was found that the timing of decompression played a big role when it came to recovering neurologically from the injury. Delay of decompression can decrease the chances of recovering from the neurological damage. One injured individual had a delay of decompression because of the need to stabilize other injuries, and he had persistent deficits in neurological function. The other two patients had immediate decompression (within 24 hours) and recovered their neurological function. Decompression after an hour post-injury led to an improvement of 85 percent of function when the same thing was done in animals within one hour of injury.
It is felt that poor circulation to the spinal cord is the cause of spinal injury in delayed treatment of traumatic spondylolisthesis. The longer the spinal cord is without blood flow, the higher is the degree of permanent ischemia and death to spinal tissue. Thirty minutes of decompression decreased flow to 49 ml/minute. But after 180 minutes of low blood flow, it dropped to 19.8 ml/minutes.
There was a case of multiple spondylolistheses from L2 to L5. Because there was little spinal cord compression, the treatment was conservative, and the patient recovered completely.
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