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Mohsen MA, Abouassi M, Albokai M, Alyousef S, Hamed A. Delayed surgical treatment of asymptomatic severe traumatic C7-T1 spondylolisthesis: a rare case report from Syria. Ann Med Surg (Lond) 2024; 86:1789-1793. [PMID: 38463103 PMCID: PMC10923267 DOI: 10.1097/ms9.0000000000001786] [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: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Spondylolisthesis is described as the displacement of one vertebra over another, leading to spinal instability and potential nerve compression. When this occurs in the cervicothoracic junction, it can result in unique clinical manifestations. High-grade spondylolisthesis caused by trauma in the cervicothoracic junction of the spine usually results in acute spinal cord injury and quadriparesis. However, a few uncommon cases of the same injury reported minimal or no neurological deficits. Biomechanical evaluation of the underlying pathology can offer insights into the mechanism of injury and the preservation of neurological function. Case presentation This paper explains the case of a 32-year-old white male patient who suffered from a traumatic C7-T1 spondylolisthesis. Despite having radiographic evidence of grade III traumatic spondylolisthesis, cord compression, fracture in the isthmus of the C7 vertebra, and intervertebral disc traumatic change and protrusion, the patient did not exhibit any motor neurological deficits. The patient underwent posterior spine fixation via the posterior approach as the first step of the surgical management, followed by anterior spine fixation via the anterior approach after several days (360° fixation). Fortunately, after 6 months of follow-up, the patient showed good outcomes. The patient was pain-free with an intact neurological clinical examination, the radiographs showed well-maintained fusion and alignment. Discussion The best management approach to cervical spondylolisthesis without neurological injury is complicated and arguable due to the rarity of occurrence of such cases. Conclusion A combined anteroposterior surgical approach, or 360° fixation, is a valuable technique for addressing complex spinal conditions such as the condition seen in our case, offering comprehensive stabilization and improved outcomes.
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Affiliation(s)
| | - Majd Abouassi
- Faculty of Medicine, Damascus University, Damascus, Syria
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Dao I, Napon S, Ouattara O, Sanou A, Nassoum E, Zabsonré SD, Kabré A. Successful management of delayed traumatic cervical spondyloptosis with neurological deficit: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE2364. [PMID: 38190693 PMCID: PMC10778140 DOI: 10.3171/case2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cervical spondyloptosis is a serious condition scarcely encountered by spine surgeons. Few cases have been reported in the literature. There are no general guidelines for their management, especially in delayed cases. The authors describe their surgical technique for the management of cervical spondyloptosis 45 days after the trauma. OBSERVATIONS A 28-year-old patient was admitted 45 days after head and cervical trauma leading to quadriplegia with muscular strength at the C5 level. Cervical computed tomography scanning and magnetic resonance imaging revealed C6-7 spondyloptosis with complete slippage of the C6 vertebral body in front of C7. Posterior and anterior cervical spine approaches during the same surgery allowed decompression and stabilization, leading to a dramatic improvement in the neurological deficit. The patient was able to walk 18 months later with near normal balance. LESSONS Traumatic cervical spondyloptosis requires early management to increase the possibility of decompression through anatomical realignment and stabilization. In delayed cases, a combined anterior and posterior cervical spine approach according to our technique allows decompression and stabilization with a good postoperative outcome possible.
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Affiliation(s)
- Ibrahim Dao
- Department of Neurosurgery, University Hospital Souro Sanou, Nazi Boni University, Bobo Dioulasso, Burkina Faso
- High Institute of Health Sciences, Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | - Salifou Napon
- Department of Intensive Care Unit, University Hospital Bogodogo, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso; and
| | - Ousmane Ouattara
- Department of Neurosurgery, University Hospital Souro Sanou, Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | - Abdoulaye Sanou
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Elie Nassoum
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Sylvain Delwendé Zabsonré
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Abel Kabré
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
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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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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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Sakti YM, Anzhari S, Kartika A, Irfantian A, Ahmad H, Sakadewa GP, Alhaq ZA, Resubun APKP, Tarsan AK. Neglected cervical spondyloptosis of the 5 TH - 6 TH cervical spine following cervical manipulation: A case report. Int J Surg Case Rep 2022; 94:106984. [PMID: 35397301 PMCID: PMC8988005 DOI: 10.1016/j.ijscr.2022.106984] [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: 02/06/2022] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
A 16-year-old boy was diagnosed with spondyloptosis of the cervical spine at the C5–6 level with a neurologic deficit following cervical manipulation. He could not move his upper and lower extremities, but the sensory and autonomic function was spared. The pre-operative American Spinal Cord Injury Association (ASIA) Score was B with SF-36 being 25%, and Karnofsky's score was 40%. The patient was disabled and required special care and assistance. We performed anterior decompression, cervical corpectomy at the level of C6 and lower part of C5, deformity correction, cage insertion, bone grafting, and stabilization with an anterior cervical plate. The patient's objective functional score had increased after six months follow up and assessed objectively with the ASIA Impairment Scale (AIS) E or Excellent, SF-36 score 94%, and Karnofsky score was 90%. The patient could carry on regular activity with minor signs or symptoms of the disease. This case report highlights severe complications following cervical manipulation, a summary of the clinical presentation, surgical treatment choices, and a review of the relevant literature. In addition, the sequential improvement of the patient's functional outcome after surgical correction will be discussed. Rare case of neglected cervical spondyloptosis Challenges in management of neglected cervical spondyloptosis Outcome of single-stage-anterior-only surgery in managing neglected cervical spondyloptosis
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Affiliation(s)
- Yudha Mathan Sakti
- Staff of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia.
| | - Sharfan Anzhari
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Andrea Kartika
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Ardicho Irfantian
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Husein Ahmad
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Galih Prasetya Sakadewa
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Zaky Asad Alhaq
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Alan Philips Kustianto Putra Resubun
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
| | - Andi Karsapin Tarsan
- Resident of Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman Regency, Yogyakarta Special Region, Indonesia
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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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AlMofreh, DDS F, AlOtaibi S, Jaber M, Bishawi, DDS K, AlShanably, DDS A, AlMutairi F. Cervical Spine Injuries and Maxillofacial Trauma: A Systematic Review. Saudi Dent J 2021; 33:805-812. [PMID: 34938019 PMCID: PMC8665169 DOI: 10.1016/j.sdentj.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/24/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify specific maxillofacial trauma patterns associated with cervical spine injuries. METHODS The protocol was developed according to (PRISMA-P) and was admitted to PROSPERO under accreditation code #CRD42020177816. Furthermore, the reporting of the present SR was conducted based on the PRISMA checklist. RESULTS Of the 1,407,750 patients recorded, a total of 115,997 patients (12.13%) had MFF with an associated CSI with a gender proportion (M:F) of 3.63:1 respectively. Motor vehicle accident was the most common cause of the combined Maxillofacial Trauma (MFT) and CSI. The most common CSI location was at the C2, followed by the C5 cervical spines. The most common location of a maxillofacial fracture resulting in a CSI was the mandible. CONCLUSION The incidence of the association of CSIs with MFT has been low (12.13%). Nevertheless, in cases of an isolated mandibular trauma due to a severe blow presenting with a low Glasgow Coma Scale, maxillofacial surgeons should be at a high alert of an associated CSI.
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Affiliation(s)
| | - Sami AlOtaibi
- Department of Oral and Maxillofacial Surgery, King Saud University, Saudi Arabia
| | - Mohamed Jaber
- Department Head, Surgical Sciences, Ajman University, United Arab Emirates
| | | | | | - Faris AlMutairi
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Saudi Arabia
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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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Kumar Rokaya P, Khadka NK, Giri PK, Khapung R, Mahaseth N. Burst Fracture of C5 with Traumatic Anterior Spondyloptosis of C6 and Posterior Spondylolisthesis of C4 Vertebra: A Case Report. JNMA J Nepal Med Assoc 2021; 59:402-405. [PMID: 34508540 PMCID: PMC8369586 DOI: 10.31729/jnma.5289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 05/09/2021] [Indexed: 11/21/2022] Open
Abstract
Burst fracture of C5 with traumatic anterior spondyloptosis of C6 and posterior spondylolisthesis of C4 vertebra is an exceedingly rare high energy injury. Treatment includes decompression, reduction, stabilization, and fusion via anterior or posterior or combined anterior-posterior approach with or without prior traction. We report this rare subaxial cervical spine injury associated with quadriplegia managed with combined anterior and posterior instrumented fusion. A multidisciplinary approach with preoperative assessment and planning is crucial in managing cervical spine injury. Immediate postoperative critical care support, rehabilitation, and dedicated nursing care are required for a favorable outcome in traumatic quadriplegia.
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Affiliation(s)
- Poojan Kumar Rokaya
- Department of Orthopedics & Trauma Surgery, Karnali Academy of Health Sciences, Nepal
| | | | - Praveen Kumar Giri
- Department of Anaesthesia and Critical Care, Karnali Academy of Health Sciences, Nepal
| | - Robin Khapung
- Department of Anaesthesia and Critical Care, Karnali Academy of Health Sciences, Nepal
| | - Nirajan Mahaseth
- Department of Anaesthesia and Critical Care, Karnali Academy of Health Sciences, Nepal
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Rai HIS, Garg K, Agrawal D. Management of Traumatic Cervical Spondyloptosis. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0040-1722554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractTraumatic cervical spondyloptosis is a 3-column fracture-dislocation resulting in a highly unstable spine requiring urgent reduction, stabilization, and fixation. Since its occurrence is not that common, there are a lot of controversies concerning its management. A holistic approach has been proposed regarding the management of traumatic cervical spondyloptosis.
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Affiliation(s)
- Hitesh Inder Singh Rai
- Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
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Kumar D, Rathod PM, Hooda A, Sodavarapu P. Flexion compression type of traumatic C7-T1 cervical spondyloptosis without neurological deficit. BMJ Case Rep 2020; 13:13/11/e239388. [PMID: 33148563 DOI: 10.1136/bcr-2020-239388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepak Kumar
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pratik M Rathod
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aman Hooda
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Praveen Sodavarapu
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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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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Two case reports of 'locked spondyloptosis': the most severe traumatic cervical spondyloptosis with locked spinous process and vertebral arch into the spinal canal. Spinal Cord Ser Cases 2020; 6:10. [PMID: 32071287 DOI: 10.1038/s41394-020-0259-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Traumatic cervical spondyloptosis, including compressive-extension stage 5 of Allen's classification of cervical spine injuries, is commonly observed; however, cases involving locked spinous process and vertebral arch into the spinal canal are extremely rare. CASE PRESENTATION We present two individuals with spondyloptosis of C7 with locked spinous process of C6 and the vertebral arch into the spinal canal. Closed reduction was unable to be performed due to rigid locking of the cervical spine in the first case, whereas preoperative closed reduction was achieved with mild traction in a prone position after general anaesthesia in the second case. These two individuals underwent spinal fusion via a posterior approach after open or closed reduction. Six months after surgery, both individuals exhibited significant neurological recovery and acquired a stable gait. DISCUSSION To the best of our knowledge, this is the first report of traumatic 'locked spondyloptosis' of the spinous process and vertebral arch into the spinal canal. Although high-grade compressive-extension injuries are usually repaired using a combined anterior-posterior approach, repair is possible with a posterior approach alone with reliable anchors, such as pedicle screws or multiple lateral mass screws. Urgent open reduction may be required for locked spondyloptosis when closed reduction is invalid due to rigid locking of the cervical spine.
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Abstract
Traumatic spinal spondyloptosis is the extreme degree of spondylolisthesis and is not common. Traumatic cervical anterior spondyloptosis has been reported but we could not find reports of posterior traumatic cervical spondyloptosis. We present an 18-year-old female with this type of injury and cervical complete cord syndrome below C5 and explain our treatment approach.
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Affiliation(s)
- Arash Fattahi
- a Iran University of Medical Sciences , Tehran , Iran
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