UP-TO DATE REVIEW AND CASE REPORT Traumatic L4-5 Spondylolisthesis: case report and literature review Rohit Jindal • Manish Pruthi • Sudhir Garg • Raj Bahadur Sharma Received: 26 December 2010 / Accepted: 1 February 2011 / Published online: 20 February 2011 Ó Springer-Verlag 2011 Abstract We report a case of traumatic L4/L5 spond- ylolisthesis caused by fall of heavy weight on the back of a construction worker. CT scan showed dislocation of left L4/5 facet with fracture of right L5 facet. MRI showed ruptured intervertebral disc suggestive of acute lesion. The patient was treated surgically 7 days after the injury and posterior L3/4/5 instrumentation with posterolateral and posterior lumbar interbody fusion using mesh cage. At 18-month follow-up, reduction was maintained and solid fusion of interbody and posterolateral grafts was achieved. Keywords Traumatic spondylolisthesis Á Circumferential fusion Introduction Traumatic spondylolisthesis is caused by a fracture in an area of osseous hook other than pars interarticularis [6]. Acute traumatic spondylolisthesis is a rare condition and usually involves lumbosacral segment, involvement of other lumbar segments is rare with only few reports in the literature [3, 8]. The purpose of current article is to draw attention to mechanism, detailed diagnosis, and management with circumferential fusion of a case of traumatic L4/L5 spondylolisthesis with preexisting sacralization of fifth lumbar vertebra. Case report A 55-year construction worker had a fall of concrete slab on his back while working. He experienced severe lumbosacral pain with radiating pain in left lower limb. On physical examination, his GCS was 15/15 and there was no associated chest or abdominal injury. The skin in the dorsolumbar region showed blue discoloration with tenderness in lower lumbar spine. Neurological exami- nation revealed numbness in L4/L5 distribution on the right side with dorsiflexion weakness of right ankle with weak EHL. Ankle jerk was absent on the right side. A normal rectal examination with normal sphincter function was found. The lateral radiograph showed anterolisthesis of L4 over L5. AP radiographs revealed sacralization of fifth lumbar vertebra (Fig. 1). CT scan of the lumbosacral region showed anterolisthesis of L4 over L5 with dislocation of left L4/5 facet with fracture of right L4 facet (Fig. 2). MRI scan verified the lesion as acute and showed rupture of intervertebral disc and posterior longitudinal ligament (Fig. 3). Patient underwent surgery 7 days after the injury. Prone position and posterior midline incision was used. Pedicle screws were inserted bilaterally at L3/4/5 levels. A partial right-sided L4/5 laminectomy was done. L4 and L5 roots were visualized, and decompression of right L5 nerve root was performed by removing offending bony fragments. The fractured right inferior L4 facet was removed, and partial facetectomy of right superior L5 facet was done. R. Jindal Á S. Garg Á R. B. Sharma Department of Orthopaedics, Government Medical College and Hospital, Sector-32, Chandigarh, India M. Pruthi (&) Department of Bone and Soft Tissue, Tata Memorial Hospital, Parel, Mumbai, India e-mail: manishpruthi@gmail.com 123 Eur J Orthop Surg Traumatol (2012) 22:61–64 DOI 10.1007/s00590-011-0773-2