Traumatic lateral spondyloptosis and lateraloptosis with partial improvement through posterior surgical approach: a review based on a case report

Abstract

Introduction. Spondyloptosis or grade V of spondylolisthesis, spinal injury that involve 100 % mobilization of the vertebral body, is rare to find. Lateraloptosis, displacement of vertebral bodies, is even more rare a catastrophic.The aim of this study to introduce readers to this rare form of traumatic lumbar spine injury as well as to review current available therapeutic approaches.Case report. A 22-year-old male was admitted to the emergency room due to a fall from a moving truck. Physical examination revealed neurological deficit in the lower extremities, with muscle strength 0/5, and an ASIA B classification. Computed tomography study showed a complete lateroloptosis at the L3 –L4 level. The patient is admitted to the operating room for surgical treatment through a posterior approach. Successful arthrodesis and spinal alignment are achieved. Immediate postoperative period, showed no complications and the patient’s neurological function in the lower extremities was classified as ASIA C. In the posterior follow-up, the patient maintains the motor neurological function and recover the autonomic control of bladder function. With mild disability according to the Barthel Index of 90 points.Discussion. of the traumatic spinal injuries, spondyloptosis is the most infrequent and occurs secondary to high-energy mechanisms. It presents an incidence of complete neurological deficit in 80 % of patients. The objectives in surgical treatment are decompression of neurovascular structures, reduction of fracture dislocation to improve alignment in the sagittal and coronal plane, and instrumentation that allows stability. The posterior surgical approach offers advantages over the anterior approach. In the posterior approach, the facet joints can be manipulated more safely, decompress the nerve roots and the dural sac more easily, as well as less operating time and greater care of vascular structures such as the iliac vessels.Conclusion. Complex traumatic spinal injuries are associated with irreversible neurological damage. Achieving spinal stability and alignment allows optimizing physical therapy and rehabilitation for greater recovery. Severe spinal injuries, especially lateroptosis, are difficult to treat by surgical approach, however, the main objective is vertebral stabilization to allow physical therapy and early rehabilitation.