Three-Grade Neurological Recovery (ASIA Impairment Scale A to D) Following Surgical Stabilization of Traumatic...

Traumatic high-grade thoracolumbar spondylolisthesis is rare and is often accompanied by severe neurological injury. We report a patient with an initial complete spinal cord injury (SCI) after a traumatic D11-D12 Meyerding Grade IV translation who subsequently achieved substantial neurological and functional recovery.

A 39-year-old woman sustained a fall of approximately 10-12 feet, resulting in severe D11-D12 translation and a complete neurological deficit, American Spinal Injury Association Impairment Scale (AIS) grade A, with a lower extremity motor score (LEMS) of 0/50. She underwent posterior reduction and D10-L1 pedicle screw fixation within 24 h of injury. Neurological and functional status were assessed serially using AIS, the International Standards for Neurological Classification of SCI, the spinal cord independence measure III (SCIM III), and the walking index for SCI II (WISCI II) at discharge and at 2 weeks, 6 weeks, 3 months, and 6 months. Neurological status improved from AIS A at presentation to AIS C at discharge and AIS D at 6 months. LEMS rose from 0/50 to 27/50, and SCIM III improved from 15/100 to 56/100 while WISCI II improved from 0/20 to 9/20, reflecting a change from dependent, non-ambulatory status to assisted ambulation. Function above the injury level remained intact throughout.

Severe traumatic Meyerding Grade IV thoracolumbar spondylolisthesis with an initial complete neurological deficit does not preclude meaningful recovery. Serial standardized neurological and functional assessment over at least 6 months is essential for accurate prognostication after severe traumatic SCI.