Traumatic L2-L3 Spondylolisthesis Without Posterior Fracture: A Case Report and Narrative Review

Introduction: Post-traumatic lumbar spondylolisthesis (SPL) is a rare injury, most commonly caused by high-energy mechanisms of trauma resulting in spinal instability and risk of neurological deficit, symptoms include lumbalgia. L5-S1 is the most frequent location of listhesis. The treatment is almost always surgical with spinal stabilization and nerve roots decompression. In this study we searched to compare similarly reported cases and their surgical outcomes.

Methods: A case report followed by a literary search on PubMed from 2019-2024 with keywords ‘Traumatic’ AND ‘Spondylolisthesis’, additionally ‘L2-L3’ without time limitation and additional search on Google Scholar was added.

Results: A 35 year old male presented with recurrent lower back pain radiating to the right L2-L3 dermatome, accompanied with dysesthesia, and a positive right straight leg raise test. Relevant history includes a fall, 5 months prior (ASIA E). Initial treatment included rehabilitation and analgesia, without improvement. X-rays and MRI showed L2-L3 spondylolisthesis with laminar protrusion, posterocentral L1-L2 disk protrusion and L5-S1 posterolateral and right foraminal disk extrusion with S1 right radiculopathy. A posterior spinal instrumentation with L2-L3 interpedicular screw fixation, foraminal decompression and L5-S1 endoscopic discectomy was performed. The patient was discharged 2 days post-operative, with significant improvement in pain.

We performed a literature search to compare post-surgical outcomes but found no results for L2-L3 SPL, Ver et al. reports 3 cases (2.4% of n= 125) with involvement of traumatic L2-L3 SPL, additionally we found 1 case of L2-L3 spondyloptosis. One other case reported traumatic double level SPL with L2-L3 involvement. Comparing traumatic L2-L3 SPL with non-traumatic SPL, still few cases with described lumbar level have been involved. The little data we did find on traumatic SPL at L2-L3, confirm known epidemiological data with overall more frequency in males with mean age 31.5. All analyzed cases underwent surgical treatment, and had relative positive outcomes.

Conclusion : Low-impact traumatic spondylolisthesis at an L2-L3 is rare, and no similar cases have been reported. Treatment with spinal instrumentation for stabilization with fixation and nerve decompression, is successful in the majority of traumatic SPL cases.