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

Abstract

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...

Post-traumatic Cervical Spondyloptosis Without Neurological Deficits: A Case Report

“…Most of the literature advocates Physical Activity on Prescription (PAP) for patients without anterior cord compression with permanent deformity with bedside traction. The Anterior Posterior-Anterior (APA) for patients with anterior cord compression and not reduced deformity intraoperative [14,15]. A cervical traction of >20 lb for 10 days may lead to neurological damages [2].…”