Traumatic, high-cervical, coronal-plane spondyloptosis with unilateral vertebral artery occlusion: treatment using a prophylactic arterial bypass graft, open reduction, and instrumented segmental fusion

Abstract

<jats:p>The authors present a case of traumatic, complete, high cervical spine injury in a patient with gradual worsening deformity and neck pain while in rigid cervical collar immobilization, ultimately resulting in coronal-plane spondyloptosis. Due to the extent of lateral displacement of the spinal elements, preoperative evaluation included catheter angiography, which revealed complete right vertebral artery (VA) occlusion. A prophylactic arterial bypass graft from the right occipital artery to the extradural right VA was fashioned to augment posterior circulation blood supply prior to reduction and circumferential instrumented fusion. Following surgery, the patient was able to participate in an aggressive rehabilitation program allowing early mobilization, and he ceased to be ventilator-dependent following implantation of a diaphragmatic pacer. The authors review factors leading to progression of this type of injury and suggest technical pearls as well as highlight specific management pitfalls, including operative risks.</jats:p>

Traumatic cervical spine spondyloptosis: A systematic review

“…Exploring arterial posttraumatic lesions with either angiography or angio-CT is justified; in fact, in this review, three patients presented vertebral artery lesions; in one case, it was a sharp angulation of one side vertebral artery and a posttraumatic pseudoaneurysm on the other side,[ 9 ] and in two cases, a total occlusion in one side. [ 10 11 ] It appears that the incidence of TCS rises the more we go down on cervical spine levels, and so, 68% of the reviewed cases are located in the lowest two levels [ Figure 4 ]; these levels are where the mobility is the least and the load is bigger. [ 12 ] TCS is dominated by anterior slippage of the superior vertebrae (anterolisthesis) in more than 83% of cases; whereas posterior form (retrolisthesis) as in our two cases is rare seen in only 10% of cases; and only one case was reported of laterolisthesis with lateral TCS (1.5%).…”

“…[ 12 ] TCS is dominated by anterior slippage of the superior vertebrae (anterolisthesis) in more than 83% of cases; whereas posterior form (retrolisthesis) as in our two cases is rare seen in only 10% of cases; and only one case was reported of laterolisthesis with lateral TCS (1.5%). [ 10 ] TCS could englobe many anatomic aspects; we recommend to distinguish two gravity stages of TCS: in Type I, there is more than 100% slippage, but the endplates are on the same axial plan; in type II, there is a projection of the superior vertebrae in front of the inferior vertebrae (like S Tetris shape) or behind the inferior vertebrae (like Z Tetris shape), performing a double body aspect on axial CT scan [ Figure 1 and Figure 2 ]. Following this classification, we note that a disunion with posterior element by bilateral pedicles and/or facet joints fractures is present in 89% of type II.…”

Successful management of delayed traumatic cervical spondyloptosis with neurological deficit: illustrative case

“…Neugebaeur first described spondyloptosis in 1882, and since then, it has most often been encountered in the lumbar spine. 5 The first reported cases of cervical spine spondyloptosis appeared in 1951, and none were traumatic. 6 It was only in 1992 that Bhojraj et al.…”

Posttraumatic C2-C3 spondyloptosis without focal neurological deficit, treated with anterior and posterior approaches: A case report

“…Cervical spondyloptosis is the most severe type of spondylolisthesis and is[ 1 ] usually attributed to trauma. [ 3 ] It usually results in a significant neurological deficit often characterized by; quadriplegia, respiratory disorders, vertebral artery injury, and even death. [ 3 ]…”

“…[ 3 ] It usually results in a significant neurological deficit often characterized by; quadriplegia, respiratory disorders, vertebral artery injury, and even death. [ 3 ]…”