Traumatic spondyloptosis resulting from high-energy trauma concurrent with a tonic-clonic seizure

Background context: Traumatic lumbosacral dislocation injuries are rare, high-energy injuries that are challenging to surgically manage. Purpose: To report a patient with a traumatic spondyloptosis of L5 on S1 as a result of bilateral pedicle fractures of L4 and L5 occurring during a motor vehicle accident, concurrent with a tonic-clonic seizure. The mechanism and treatment of the injury are discussed. Study design: Clinical case report and literature review. Methods: A staged circumferential fusion was performed with posterior reduction of L5 to the sacrum and instrumentation and fusion from L2 to the pelvis, followed 12 days later by anterior diskectomies and arthrodesis from L3 to S1. Results: Near anatomic reduction and solid fusion were obtained and maintained at 3-year follow-up. The patient remained neurologically intact in all lumbosacral roots throughout the course of treatment. Conclusions: The injury pattern described is quite rare. This case of multilevel, bilateral pedicle fracture with traumatic L5-S1 spondyloptosis was successfully treated by circumferential reduction and arthrodesis without neurological injury.