Management of Traumatic C6-7 Spondyloptosis with Cord Compression

Choi, Minsu; Jo, Dae Hyun; Kim, Min-Ki; Kim, Taesung

doi:10.3340/jkns.2014.55.5.289

Cited by 10 publications

(16 citation statements)

References 12 publications

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“…The most accepted approach is the combined anterior and posterior 360º or 540º, with or without corpectomies. This approach provides wide canal decompression and successful cervical spine realignment (1)(2)(3)(4)(5)(6)(7)(10)(11)(12)(13). Additionally, the management of chronic spondylisthesis would have some considerations according to our experience.…”

Section: Discussionmentioning

confidence: 99%

“…The initial management of these fractures is generally a cervical traction to achieve a closed reduction that may allow a subsequent spinal stabilization with an anterior, posterior or combined approach (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Nevertheless, in the chronic spondyloptosis (4) or high grade spondylolisthesis the treatment of the patient became a challenge to achieve a correct spinal alignment avoiding the worsening of the neurological status.…”

Section: Case Reportmentioning

confidence: 99%

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Treatment of chronic traumatic C7–T1 grade III spondylolisthesis with mild neurological deficit: case report

et al. 2017

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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. Case ReportTraumatic subaxial cervical luxations are typically produced by high-energy mechanisms and are associated with major spinal cord injury and mechanical instability. Cervicothoracic spondyloptosis or severe spondylolisthesis is an especially severe injury, usually with an easy diagnosis in the initial evaluation of a traumatic patient. Although there are cases reported of neurologically intact patients, the delay in the diagnosis is extremely rare (1,2). We present a case of a C7-T1 grade III spondylolisthesis identified 9 months after the traumatic event with mild progressive pyramidal symptoms in the lower limbs.The initial management of these fractures is generally a cervical traction to achieve a closed reduction that may allow a subsequent spinal stabilization with an anterior, posterior or combined approach (1-12). Nevertheless, in the chronic spondyloptosis (4) or high grade spondylolisthesis the treatment of the patient became a challenge to achieve a correct spinal alignment avoiding the worsening of the neurological status. Case presentationA 33-year-old female, without other medical pathologies or neurological damages, was admitted to the emergency room after a road traffic collision. The initial neurological examination was normal. The cervical spine plain radiography, in which the cervicothoracic union was not well defined, was considered normal (Figure 1). The patient was discharged with mild cervical pain. The pain remained approximately 8 weeks after the accident but no more radiological exams were made. Progressive subjective mild motor weakness and numbness of the lower limbs appeared progressively six-seven later. Nine months after the accident she was evaluated by a neurologist. The J Spine Surg 2017;3(1):82-86 jss.amegroups.com exploration revealed brisk reflexes in her lower limbs and decreased sensation at level at C7; there were no objective motor deficits (ASIA score D). The cervicothoracic MRI and CT (Figures 2,3) showed a C7-T1 tr...

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Treatment of chronic traumatic C7–T1 grade III spondylolisthesis with mild neurological deficit: case report

et al. 2017

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“…In combined approach, it is matter of debate that which step should be taken first. Proponent of anterior first approach 11,12 says that the approach provides stabilization in cases with significant disc herniation and prevent the risk of additional trauma in case of turning the patient on the operation table for the posterior approach. In a retrospective analysis of high-grade spondylolisthesis, Sribnick et al found the combined approach as the best treatment option available.…”

Section: Surgical Approachesmentioning

confidence: 99%

Anterior-Only Approach for Posttraumatic Subaxial Cervical Spine Spondyloptosis: A Case Report and Review of Literature

Kumar

Singh

Das

et al. 2019

IJNS

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Subaxial posttraumatic spondyloptosis is a rare entity with management dilemma in the literature. Various approaches have been discussed, but few reports focused on management plan and rationale. The authors reviewed the literature and reported a case of a 30-year-old woman presented with posttraumatic spastic quadriparesis. The patient had C6–7 spondyloptosis and was operated by anterior-only approach. There was improvement in both motor and sensory neurologic status. Surgical goals include vertebral realignment and stabilization. The authors conclude that anterior approach may be good enough if performed properly even if all three columns are involved.

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“…Spondyloptosis is complete fracture dislocation and subluxation in the coronal or sagittal plane defined as grade V spondylolisthesis. 3 4 5 6 15) It is very rare, but when it does occur, severe neurological deficits are common due to transection of the spinal cord. 9 10) It usually results from birth trauma, congenital anomalies, neoplastic disease and high-energy injury.…”

Section: Introductionmentioning

confidence: 99%

“… 1 2 11 13) The main mechanism of trauma is hyperextension-compression. 3) There have been a few reports of treatment of cervical spondyloptosis, which involved conservative care, only posterior fusion or combined anterior and posterior fusion. 2 3 7 8 12 14 15) Surgical decompression, reconstruction and stabilization of spondyloptosis allow for early mobilization and rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Management of Traumatic Cervical Spondyloptosis with an Unsealable Dura Tear: A Case Report

Kwun

Kim

Lee

et al. 2021

Korean J Neurotrauma

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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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Management of Traumatic C6-7 Spondyloptosis with Cord Compression

Cited by 10 publications

References 12 publications

Treatment of chronic traumatic C7–T1 grade III spondylolisthesis with mild neurological deficit: case report

Treatment of chronic traumatic C7–T1 grade III spondylolisthesis with mild neurological deficit: case report

Anterior-Only Approach for Posttraumatic Subaxial Cervical Spine Spondyloptosis: A Case Report and Review of Literature

Management of Traumatic Cervical Spondyloptosis with an Unsealable Dura Tear: A Case Report

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