Traumatic spondylolisthesis of the subaxial cervical spine is a rare occurrence, and few cases have been reported. Ido et al. [15] reported that the condition was first described by Perlman and Hawes in 1951. Patients usually present with a complete, or rarely a partial, neurological deficit with radicular symptoms. Historically, a combined anterior and posterior fusion procedure is advocated for these unstable injuries [16]. The vast majority of literature regarding traumatic spondylolisthesis of the lower portion of the cervical spine is in the form of case reports.

Srivastava et al. [16] presented their management of a C3−C4 spondyloptosis in a 35-year-old man who suffered a fall of approximately 20 feet and landed on his forehead. He had complete spondyloptosis of C3 on C4 with bilateral pedicle fractures at C3, fracture of the C1 arch, and bilateral C2 pedicle fractures secondary to severe hyperextension force with associated axial load. The patient was neurologically intact. Computed tomographic (CT) scanning and magnetic resonance imaging (MRI) were performed and revealed no lamina or facet fractures and no spinal cord compression or signal abnormality. MRI is essential in this patient population to rule out the presence of disc fragments within the spinal canal. The group elected to treat the patient first with a reduction maneuver. An awake, nasotracheal fiberoptic intubation was performed, and, with the patient awake, gradual weight was added to Gardner-Wells tongs and traction was applied. Fluoroscopic guidance was used to assess reduction. The neck was kept in neutral flexion-extension during the reduction maneuver. Once acceptable alignment was achieved and the patient remained neurologically intact, anterior cervical discectomy and fusion were performed at C3−C4. The group opted for anterior stabilization only, as opposed to a multi-stage anterior and posterior procedure, in an effort to avoid the destabilizing effects that can result from a posterior procedure. However, the requirement for anterior-only stabilization is anatomic reduction of the posterior elements with acceptable alignment and appropriate postoperative immobilization to allow for fracture healing. Furthermore, in cases in which neurological deficit is present, a posterior procedure might be necessary such that decompression can be performed [16].

Similarly, Shah and Rajshekhar [17] and Ido et al. [15] described, in their respective case reports, management of a C7−T1 spondyloptosis and C6−C7 traumatic spondylolisthesis, respectively. Again, both patients suffered a fall from height with associated hyperextension injuries and axial load. In each instance, a reduction maneuver was performed with careful assessment of neurological function. Anterior cervical discectomy and fusion were then performed. In each case, an anterior-only construct was thought to afford adequate stability and the patient was spared the morbidity of a combined approach [15, 17].

Traumatic spondylolisthesis of the lumbar spine is a rare entity, with only 100 reported cases since Watson-Jones [18] described the condition in 1940. The majority of reported cases are traumatic lumbosacral dislocations, with dislocation at the L5−S1 level. In the lumbar spine, the facets are able to slide past each other in extension. This minimizes the chance of facet fracture occurring secondary to hyperextension in the lumbar spine, as is often seen in the cervical spine. The facet joints in the lumbar spine are oriented in a sagittal plane, making them able to resist rotation but not flexion or translation. They do not support an axial load unless an extension posture is assumed. Furthermore, the angle of the sacrum in relation to the L5 body at the lumbosacral junction will impact the development of a pathological process in this region (i.e., the greater the lumbosacral joint angle is, the greater the applied translation force will be). The coronal nature of the facet joints at L5−S1 also explains why traumatic spondylolisthesis occurs most frequently at this level [1].

A variety of mechanisms have been proposed as the mechanism of injury in traumatic spondylolisthesis of the lumbar spine. Watson-Jones [18] suggested hyperextension stress, and Roaf [19] suggested hyperflexion, axial rotation, and compression forces. According to Deniz et al. [1], many cite hyperflexion and compression as the main deforming force for anterior or anterolateral lumbosacral dislocation, although some case reports of direct force tangential to the apophyseal joint and hyperextension with compression have been presented. The injury is characterized by disruption of the supra- and intraspinous ligaments and the joint capsules. The ALL, PLL, and disc might remain intact [20].