A Modified Gaines Approach for Lumbosacral Traumatic Spondyloptosis: A Historical Review and Case Illustration

Abstract

Spondyloptosis is defined as greater than 100% subluxation of one vertebra over another; it most commonly develops due to dysplastic spondyloslisthesis but can also develop as a result of traumatic fracture-dislocations. In the past, given the significant force associated with this injury, most patients did not survive the initial trauma and resuscitation. However, as early care of patients with multiple traumatic injuries continues to improve, a larger number of patients with traumatic spondyloptosis will require treatment. In general, the goals of surgical intervention are to treat symptoms, preserve and improve neurologic status, restore and maintain sagittal balance, and obtain a solid arthrodesis while fusing as few segments as possible. There is, however, considerable controversy about specific surgical management in achieving these goals. We present a case of traumatic spondyloptosis including a discussion of our surgical approach, which is a modified Gaines procedure with a corpectomy, interbody fusion, and posterior spinal decompression and fusion. Alternate approaches are also discussed from both our institutional experience and from a review of the current literature.