Traumatic spondyloptosis of L3 with incomplete neurological involvement: A case report

Prasad

Indian Journal of Neurosurgery

et al. 2021

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.

Section: Discussionmentioning

confidence: 79%

Section: Cause Of Higher Incidence Of Spondyloptosis At This Locationmentioning

confidence: 99%

Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center

Prasad

Indian Journal of Neurosurgery

et al. 2021

“…Most spinal fracture dislocations occur at the thoracolumbar or lumbosacral junctions 11,12 and often result in severe neurological deficits. The midlumbar location of the injury in this report is atypical and may be due to increased lateral forces at the apex of the patient's scoliosis.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have shown that neurological improvement requires surgical intervention to decompress and stabilize the spine. 4,8,11,13,14 There have been reports of successful closed reduction in spondyloptosis 12,15 and in partial lateral dislocation 16 ; however, reduction in lateraloptosis requires greater distraction forces because of the proximity of the involved vertebral bodies. 2,9 This case features several unique elements, including what the authors believe to be the first report of closed reduction for a case of lateraloptosis.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Closed Reduction of Traumatic Lateraloptosis: Operative Nuances

Powers,

Garcia,

Nwajei

et al. 2023

Operative Neurosurgery

BACKGROUND AND IMPORTANCE: Traumatic lateral spondyloptosis, or lateraloptosis, is the complete lateral dislocation of the spine. Reduction in these dislocations presents unique challenges, especially in cases of preserved neurological function. Open techniques carry significant risks of cerebrospinal fluid leak and neurological injury. For traditional spondyloptosis, off-table closed techniques have been described but may result in loss of the reduction when the patient is transferred to the operative table. An on-table closed reduction technique has potential advantages over previously described open reduction or off-table techniques for the treatment of lateraloptosis. CLINICAL PRESENTATION: The authors describe an on-table closed reduction technique for lateraloptosis, presenting an illustrative case in which the technique was applied. This technique is compared with alternative open and off-table reduction techniques described in the literature. The patient had good mechanical and neurological outcomes. At 14 months postoperatively, she is neurologically intact, back to work involving heavy lifting, and has only moderate back pain. CONCLUSION: On-table closed reduction before open fixation should be considered in cases of lateraloptosis, particularly when there is preserved neurological function.

“…Traumatic lumbar spondyloptosis most frequently occurs at the L4-L5 and L5-S1 levels and is associated with severe neurological deficit [ 8 ]. The injury mechanism of the patient would be compatible with the shear-type of fracture-dislocation, according to the report of Denis group [ 9 ], where all three columns were disrupted.…”

Section: Discussionmentioning

confidence: 99%

Traumatic lateral spondyloptosis of L2 with complete neurological deficit: A case report

Zhao¹,

Lan²

2020

Trauma Case Reports

Traumatic spondyloptosis of the lumbar spine is an uncommon and severe clinical entity, which is defined as complete fracture dislocation and subluxation (>100%) of one vertebral body in the coronal or sagittal plane from its adjacent vertebra. In coronal spondyloptosis the subluxated vertebral bodies lie beside each other, and the condition is lateraloptosis. Clinical case A male patient aged 56 years had multiple injures with complete neurological deficit. Computed tomography(CT) revealed as spondyloptosis, which L2 detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. We performed an en bloc corpectomy and iliac bone combined part of the vertebra body replanted in situ with posterior transpedicular fixation of T12-L4, with the sagittal balance recovered and motor function improved progressively. Conclusion Traumatic spondyloptosis requires an early resolution by a trained surgical team to ensure sagittal re-alignment for a progressive neurological recovery.