Lumbosacral Traumatic Spondylolisthesis L5 to S1—Classification and Surgical Management of a Difficult Presentation

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Figure 1
(A) Lateral lumbosacral radiograph showing spondylolisthesis at L5–S1. (B and C) Lumbosacral computed tomography (CT) axial slice showing a fracture of the facet joint L5 and S1 with translation of L5 on S1. (D) Sagittal lumbosacral axial CT showing translation of the vertebral body L5 on S1 with measurement of the translation. (E) Axial CT with 3-dimensional reconstruction of the lumbosacral spine showing the facet joint fractures and rotation mechanism in the L5–S1 segment.
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Figure 2
Nuclear magnetic resonance imaging for simple lumbosacral spine showing ligamentous and disc compromise of the L5–S1 segment with invasion of the spinal canal.
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Figure 3
Axial computed tomography of the lumbosacral spine with 3-dimensional reconstruction. Arthordesis and instrumentation of the L5–S1 segment with placement of a transforaminal cage (transforaminal lumbar interbody fusion) is indentified with axial and sagittal slices, which show reduction of anterior translation and rotation of the vertebral body of L5.

Table

Description made by the authors based on the illustrations of Vialle et al.9

Type	Description
I	Dislocation of facet joints without fracture.
A	Unilateral rotatory dislocation secondary to traumatic rotational forces.
B	Bilateral facet joint dislocation with lateral displacement.
C	Bilateral dislocation with anterior displacement of the L5 vertebra.
II	Unilateral dislocation of the articular process due to rotational fracture.
III	Bilateral fracture dislocation with anterior displacement and disc injury.
A	Bilateral fracture with anterior displacement of L5. This type of fracture can go through the pars interarticularis.
B	Bilateral fracture with rotational displacement associated with L5 slippage.