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

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.

Thecal sac ligation in the setting of thoracic spondyloptosis with complete cord transection

“…[ 7 , 19 , 20 ] However, in cases of complete cord transection and spinal cord injury, durotomy may not always be repaired. [ 9 , 16 ] One case of traumatic TS with complete cord transection at T7–8 reports success with the insertion of a drain without dural repair. [ 9 ] However, Kwun et al .…”

“…[ 10 , 29 , 30 ] Five (38.5%) were from India, and one (7.7%) was from Korea, Japan, Greece, Iran, and Turkey each. [ 1 , 3 , 9 , 12 - 14 , 16 , 22 , 28 , 32 ] Cases from Iran, Korea, India, Turkey, and USA described their approach to the dural defect. [ 7 , 9 , 12 - 14 , 16 , 22 , 30 , 31 ]…”

“…[ 1 , 3 , 9 , 12 - 14 , 16 , 22 , 28 , 32 ] Cases from Iran, Korea, India, Turkey, and USA described their approach to the dural defect. [ 7 , 9 , 12 - 14 , 16 , 22 , 30 , 31 ]…”

“…[ 9 , 16 ] The cord was transected at T7–8 level in one case and C5–6 level in the other. [ 7 , 16 ] There was no postoperative CSF complication in the case of thoracic spondyloptosis. [ 9 ] In the case of cervical spondyloptosis, postoperative CSF leak required a second operation during which the dura was sutured both cranially and caudally to the defect.…”

“…[ 9 ] In the case of cervical spondyloptosis, postoperative CSF leak required a second operation during which the dura was sutured both cranially and caudally to the defect. [ 16 ] There were no further CSF leaks. Neither case had improvement in paraplegia or quadriplegia, respectively.…”