Traumatic cervical spine spondyloptosis: A systematic review

Abstract

Background: Spondyloptosis is a rare presentation of cervical spine traumatism where listhesis is more than 100%. Traumatic cervical spine spondyloptosis (TCS) is one of the least discussed forms of cervical spine traumatisms because of its rarity and the gravity of patient's condition, limiting good management, and the number of reported cases. Objectives: This study aimed to discuss clinical, radiological, and best management tools of the aforementioned pathology. Materials and Methods: Scopus, ScienceDirect, PubMed, and Google Scholar databases were searched for English articles about traumatic cervical spondyloptosis. Titles, abstracts, or author-specified keywords that contain the words “spondyloptosis” AND “cervical” AND “spine” were identified. There were no time limits. In sum, 542 records were identified, 63 records were screened, and 46 records were included in this review, describing 64 clinical cases of traumatic cervical spondyloptosis. The clinical cases of two patients managed at our department are also presented and included. In the end, 66 cases were included in this study. Demographics, clinics, radiology, management tools, and outcome of the reviewed cases were discussed. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2009. The American Spinal Injury Association Impairment Scale (AIS) score was used to evaluate the clinical presentations. Results: This review included 66 patients consisting of 46 males (70%) and 20 females (30%), with a mean age of 41 years. The accident was indicated in 62 cases; it was a road traffic accident in 29 cases (46%), a fall in 24 cases (38%), and motor vehicle accident in 15 cases (24%). The lesion was iatrogenic in four patients. Twenty-one patients were received without motor or sensitive deficit and so scored Grade E on AIS, 10 with Grade D, 11 Grade C, four Grade B, and 20 with Grade A. On imaging, spondyloptosis involved the C1–C2 segment in two cases (3%), C2–C3 in three cases (5.5%), C3–C4 in one case (1.5%), C4–C5 in six cases (9%), C5–C6 in nine cases (13%), C6–C7 in 20 cases (30%), and C7–T1 in 26 cases (38%). In all cases, there was either fracture or dislocation in posterior elements. Bilateral pedicles or facet joint fractures were noted in 53% of the 56 patients where the associated lesions were described, but it jumps to 89% when a vertebra is projected in front of another. In two cases, there was no mention of closed reduction via transcranial traction; in 13 cases (20%), it was avoided for a reason (child, patient's refusal,…). In the 51 cases where the traction was clearly applied, 17 cases (33%) were reduced totally; in 13 cases (25%) the reduction was partial; it failed in 19 cases (37%); and in the remaining cases, the result was not clear. Traction weight varied from 4 kg to 27.2 kg, applied from 6 h to 20 days. Where total reduction was achieved, an average weight...

Management of Neglected Post-traumatic C4/C5 Spondyloptosis in a Low Resource Setting: a Review of Literature and Case Study.

“…7,14 The outcomes of cervical spondyloptosis are usually noted to be poor; however, within the limits of reported cases, neurological improvement was observed in 40%, with a mortality of 11% recorded. 3,21 Our index case had resolution of autonomic dysfunction with motor improvement from AIS C to D as of the 4th week post-operation. We are optimistic about improved motor activity with continued physiotherapy and the surgical release of both knee contractures.…”

“…An all-out non-operative approach has been tried, but the outcome appears poor, with a high conversion rate to open reduction, and mortality reported in one. 3,17 In our index case, preoperative Gardner well traction was instituted to achieve some degree of reduction before surgery, and ameliorate the associated paraspinal spasms. This was achieved with a reduction to grade one listhesis (Fig.…”

Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal

“…10 The systematic review of cervical spondyloptosis also had a male preponderance of 70% with a mean age of 41 years. 11 In a most recent study comprising 17 patients, the mean age was 34.5 years, male to female ratio of 2.4:1. 7 The mean age of the cohorts in our study was 40 years and the male: female ratio was of 15:1.The most common level of involvement was at T10-L2 (55%), a mechanical transitional zone.…”

“…The study pertaining to cervical spondyloptosis had the involvement of the lower cervical spine (C6-C7 and C7-T1) in 68% of cases. 11 The same levels were involved in 45.45% of our study. This may be owing to the higher load with compromised mobility in the region.…”

Non-traumatic complete cervical spine dislocation with severe fixed kyphosis: successful multidisciplinary approach to a challenging case

“…Radiographs and CT showed a complete dislocation with locked facets at the C4–C5 level. The displacement was particularly severe, as the C4 vertebral body had more than 100% anterolisthesis and a “fall” on the anterior aspect of the C5 body, described as anterior “spondyloptosis” of C4 [ 8 , 16 ]. In contrast to previous observations combining spondyloptosis and traumatic separation of the posterior vertebral elements (spondylolysis), the present case was characterized by an intact posterior arch responsible for severe kyphosis and head drop.…”