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Judy BF, Tracz JA, Rincon-Torroella J, Ahmed AK, Witham TF. Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails. Spinal Cord Ser Cases 2023; 9:46. [PMID: 37666812 PMCID: PMC10477183 DOI: 10.1038/s41394-023-00604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Cervical spondyloptosis is a rare complication of high-energy trauma which often results in significant patient morbidity and mortality. The authors present a case of spondyloptosis of C7 over T1 with minimal radicular symptoms and otherwise complete spinal cord sparing. This case highlights the surgical challenges faced with cervical spondyloptosis and the techniques used when traction fails. CASE PRESENTATION A 21-year-old man with no significant past medical history presented after a high-speed motor vehicle collision with cervicothoracic pain and mild hand grip weakness in addition to numbness of the fourth and fifth digits bilaterally (American Spinal Injury Association Impairment Scale Grade D). Computed tomography imaging revealed spondyloptosis of C7 over T1, a fracture of the C2 vertebral body, and a burst fracture of C3. To relieve spinal cord compression and restore sagittal realignment, closed reduction was attempted, however this resulted in perching of the bilateral C7-T1 facets, leading to an open posterior approach. The patient underwent C7 laminectomy, bilateral C7-T1 facetectomy, and manual reduction using a Mayfield skull clamp followed by C2-T3 fixation. Postoperatively, pain was diminished, sensory disturbances were resolved and the patient was otherwise neurologically stable. DISCUSSION There is a role for closed traction for reduction of cervical spondyloptosis, however, its role is debated especially when the patient is predominately neurologically intact. In this setting, the spine surgeon may be required to change traction and operative strategies in order to minimize potentially harmful manipulation while restoring sagittal realignment and stabilizing the spine for preservation of neurological function.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Jovanna A Tracz
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
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Rocha-Maguey J, Ramón Martinez-Pablos J. COMPLETE NEUROLOGICAL RECOVERY AFTER A CHRONIC C6-C7 SPONDYLOPTOSIS WITHOUT POSTERIOR ARCH FRACTURE. A NEW CASE REPORTED. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Cheng L, Qiu C, Liu XY, Sang XG. Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries: A case report and literature review. Chin J Traumatol 2023; 26:33-40. [PMID: 35868949 PMCID: PMC9912182 DOI: 10.1016/j.cjtee.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/28/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.
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Affiliation(s)
- Lin Cheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, 250012, China; Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Cheng Qiu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xin-Yu Liu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xi-Guang Sang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, 250012, China.
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Ng C, Feldstein E, Spirollari E, Vazquez S, Naftchi A, Graifman G, Das A, Rawanduzy C, Gabriele C, Gandhi R, Zeller S, Dominguez JF, Krystal JD, Houten JK, Kinon MD. Management and outcomes of adult traumatic cervical spondyloptosis: A case report and systematic review. J Clin Neurosci 2022; 103:34-40. [DOI: 10.1016/j.jocn.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
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Singh R, Prasad RS, Singh A, Singh K, Sahu A. Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1726608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives.
Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant.
Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis.
Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Ravi Shankar Prasad
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Ashvamedh Singh
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Kulwant Singh
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Anurag Sahu
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
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Kwun JW, Kim SY, Lee SK, Kim YJ. Management of Traumatic Cervical Spondyloptosis with an Unsealable Dura Tear: A Case Report. Korean J Neurotrauma 2021; 17:180-185. [PMID: 34760831 PMCID: PMC8558025 DOI: 10.13004/kjnt.2021.17.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Cervical spondyloptosis is defined as dislocation of the spinal column, most often caused by trauma. Due to transection of the spinal cord, severe neurological deficits are common. Here, we reviewed the case of a young man who presented with mental stupor and complete tetraplegia below the level of C5. The patient's left shoulder was sucked into a machine and subjected to strong lateral bending and distraction. Computed tomography (CT) scan and magnetic resonance imaging revealed fracture dislocation and complete transection of the spinal cord at the C5–6 level. Three-dimensional CT scan showed coronal and sagittal spondyloptosis. He underwent open reduction with two surgeries performed via the anterior and posterior approaches: C5–6 anterior cervical discectomy and fusion and lateral mass screw fixation with allograft from C3 to C7. In addition, both ends of the huge dura defect were sutured. We report the clinical history, imaging findings, and surgical management of spondyloptosis with a complete transected spinal cord containing a considerable dura tear.
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Affiliation(s)
- Jeong Woo Kwun
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Sang Yoon Kim
- Department of Radiology, Dankook University Hospital, Cheonan, Korea
| | - Sang Koo Lee
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Young Jin Kim
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
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Payne C, Gigliotti MJ, Castellvi A, Yu A, Lee PS. Traumatic C7-T1 spondyloptosis without neurological injury: Case review and surgical management. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2020.100678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wong KE, Chang PS, Monasky MS, Samuelson RM. Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends. Surg Neurol Int 2017; 8:89. [PMID: 28607823 PMCID: PMC5461573 DOI: 10.4103/sni.sni_434_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/09/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Cervical spondyloptosis is defined as the dislocation of the spinal column most often caused by trauma. Due to compression or transection of the spinal cord, severe neurological deficits are common. Here, we review the literature and report a case of traumatic C5–6 spondyloptosis that was successfully treated using an anterior-only surgical approach. Methods: The patient presented with quadriplegia and absent sensation distal to the C5 dermatome following a rollover motor vehicle accident. The preoperative American Spinal Injury Association Impairment Scale was A. Computed tomography of the cervical spine revealed C5–6 spondyloptosis, lamina fractures on the right side at the C3–4 level, and widened facet joint on the right side at C6–7. Results: The patient underwent cervical traction and anterior cervical discectomy and fusion at the C5–6, C6–7 levels; no 360° fusion was warranted. Six months postoperatively, the patient remained quadriplegic below the C5 level. Conclusion: Presently, no consensus is present regarding the best treatment for spondyloptosis. Worldwide, the 360° approach is the most commonly used (45%), followed by anterior-only surgery (31%) and posterior-only surgery (25%). The surgical choice depends upon patient-specific features but markedly varies among geographical regions.
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Affiliation(s)
- Kelly E Wong
- Department of Neurological Surgery, University of South Dakota, Sanford School of Medicine, SD, USA
| | - Peter S Chang
- Department of Neurological Surgery, University of South Dakota, Sanford School of Medicine, SD, USA
| | - Mark S Monasky
- Neurological Surgery, Rapid City Regional Hospital, Rapid City, SD, USA
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Mata-Gómez J, Ortega-Martínez M, Valencia-Anguita J, Gilete-Tejero I, Royano-Sánchez M. Treatment of chronic traumatic C7-T1 grade III spondylolisthesis with mild neurological deficit: case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2017; 3:82-86. [PMID: 28435924 PMCID: PMC5386908 DOI: 10.21037/jss.2017.02.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/08/2017] [Indexed: 06/07/2023]
Abstract
Traumatic cervical severe spondylolisthesis is a rare and severe lesion which is typically associated with a spinal cord injury. Nevertheless, it occasionally has a pauci-symptomatic course which may delay its diagnosis. The authors report an exceptional case of a 33-year-old woman who had mild spasticity in her lower limbs and neck pain 9 months after a traffic accident. The computed tomographic scan and magnetic resonance image revealed C7-T1 grade III spondylolisthesis and spinal cord signal change. The initial cervical traction did not obtain a spinal realignment. An anterior-posterior approach was performed to achieve a correct spinal fusion. After 18 months of follow-up care, the patient's symptoms improved significantly and she began to lead a normal life again. The case underlines the importance of performing a correct initial diagnostic workup upon a patient. This would improve surgical management by avoiding a worsening of the initial neurological deficit during the realignment maneuvers in the chronic grade III, IV or V spondylolisthesis.
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Affiliation(s)
- Jacinto Mata-Gómez
- Department of Neurosurgery, Hospital San Pedro de Alcántara, Av. Pablo Naranjo s/n. 10003 Cáceres, Spain
| | - Marta Ortega-Martínez
- Department of Neurosurgery, Hospital San Pedro de Alcántara, Av. Pablo Naranjo s/n. 10003 Cáceres, Spain
| | - Julio Valencia-Anguita
- Department of Neurosurgery. Virgen del Rocio University Hospital, C/Manuel Siurot s/n. 41006 Seville, Spain
| | - Ignacio Gilete-Tejero
- Department of Neurosurgery, Hospital San Pedro de Alcántara, Av. Pablo Naranjo s/n. 10003 Cáceres, Spain
| | - Manuel Royano-Sánchez
- Department of Neurosurgery, Hospital San Pedro de Alcántara, Av. Pablo Naranjo s/n. 10003 Cáceres, Spain
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Choi MK, Jo DJ, Kim MK, Kim TS. Management of traumatic c6-7 spondyloptosis with cord compression. J Korean Neurosurg Soc 2014; 55:289-92. [PMID: 25132938 PMCID: PMC4130957 DOI: 10.3340/jkns.2014.55.5.289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/23/2013] [Accepted: 05/15/2014] [Indexed: 11/27/2022] Open
Abstract
A case of total spondyloptosis of the cervical spine at C6-7 level with cord compression is described in a 51-year-old male. Because the bodies of C6 and 7 were tightly locked together, cervical traction failed. Then the patient was operated on by a posterior approach. Posterior stabilization and fusion were performed by C4-5 lateral mass and C7-T1 pedicle screw fixation and rod instrumentation with bridging both C4-5's rods to the C7-T1's extended ones. After C6 total laminectomy and foraminotomy, the C6 body was returned to its proper position. Secondly, anterior stabilization and fusion were performed by C6-7 discectomy with a screw-plate system. A postoperative lateral plain radiograph showed good realignment. In this case, we report the clinical presentation and discuss the surgical modalities of C6-7 total spondyloptosis and the failed close reduction.
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Affiliation(s)
- Man-Kyu Choi
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Min-Ki Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Tae-Sung Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
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