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1219 - Autonomic dysreflexia due to grade I L3/L4 retrolisthesis: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

SL

Steven Le, MD

Resident Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States

Co-Author(s)

CW

Christian Wirawan, DO

Resident Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States
RL

Raymond Lee, MD

Attending Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States

Case Diagnosis: A 46-year-old female with C8 sensory T1 motor ASIA B paraplegia secondary to T2 vertebral body fracture from a gunshot wound

Case Description: The patient presented with several months history of persistent symptoms of autonomic dysreflexia including blurry vision, perspiration above the level of injury, spasticity and headaches. Her symptoms were worse when lying down supine or reclining in her wheelchair; and relieved by sitting up or lying on her side. Physical exam demonstrated development of dysreflexic symptoms with provocative maneuvers of supine position, and resolution of symptoms with lumbar flexion. Common etiologies for autonomic dysreflexia were evaluated and negative. X-ray and CT of the lumbar spine demonstrated L3 on L4 grade I retrolisthesis.

Discussions: Given retrolisthesis was grade I, conservative treatment was pursued. The patient was advised to maintain hip flexion when lying supine or side lying in bed. At subsequent follow-up visits, the patient reported resolution of dysreflexic symptoms with conservative measures. This is the first reported case, to our knowledge, of retrolisthesis of the lumbar spine causing autonomic dysreflexia in patients with spinal cord injury. Symptoms were posture-dependent and resolved with conservative measures. Possible contributing factors leading to the development of retrolisthesis in this patient include recent weight gain preceding symptoms, impaired mobility in the context of spinal cord injury, history of spinal cord injury.

Conclusions: Retrolisthesis can be a precipitant of autonomic dysreflexia and should be considered when common triggers of autonomic dysreflexia have been ruled out.