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Case Report of a Rare Spinal Injury
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Posted on: 11/30/1999
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Only 48 cases of traumatic L5/S1 spondylolisthesis have ever been reported. A traumatic fracture in the last vertebra in the low back is rare. Spondylolisthesis is the slippage of one bone over another in the spine. After the lumbar bone breaks, it slides forward over the bone below it.
This type of spinal fracture and dislocation must be treated right away. As the L5 vertebra slips forward over the S1 segment, the end of the spinal canal narrows. This puts pressure on the nerves in the spinal canal. This condition is called cauda equina. Permanent nerve damage can result.
What's the best way to treat this problem? Open surgery to realign the bones and fuse the spine is advised. How do we know this? We learn from case reports like this one. When only a small number of cases exist, doctors rely on reports from other physicians who have treated similar patients.
In this case report, a 21-year old man was thrown from a car and had a L5/S1 fracture- dislocation. X-rays, CT scans, and MRIs were all used to find the problem. These imaging studies helped the doctors see bone fractures, bone slippage, disc rupture, and damage to the ligaments. With this information, the doctors could plan the best operation for the problems present.
The operation was a success, and the patient recovered with only slight and occasional low back pain. There was also an area of numbness on the right foot. Reporting these findings is important for future cases of traumatic L5/S1 spondylolisthesis. Previous cases treated in different ways haven't always done so well.
The authors conclude that case reports and modern imaging studies make it possible to successfully treat rare traumatic injuries. In this case, quickly removing bone and fragments took pressure off the nerves. The severe damage was minimized, and the patient had a good final result.
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References:
Martin Lamm, MD, et al. Acute Traumatic L5-S1 Spondylolisthesis. Case Report. In Journal of Spinal Disorders & Techniques. December 2003. Vol. 16. No. 6. Pp. 524-527.
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