Traumatic Cervical Spondyloptosis Research Articles

Successful Management of Traumatic Cervical Spondyloptosis with Incomplete Neurological Deficit in a Child: A Case Report

Abstract Background: Spondyloptosis is a condition in which one vertebral body is completely displaced over the corpus of the adjacent one. It is more common in the lumbar region of the spine, but it very rarely occurs in the cervical spine. In this study, we report a case of post-traumatic cervical spine spondyloptosis in a child. Case Report: We describe a case of a 14-year-old male, who was admitted for cervicalgia with incomplete neurological deficit as a result of falling from a tree. Computed tomography (CT) of the neck revealed a posterior C5–C6 spondyloptosis with anterior spondylolisthesis of C7–T1. Surgical intervention was performed by the anterior approach only. The patient recovered completely after 2 months. Conclusion: Traumatic cervical spondyloptosis is an injury with rare occurrence with varied clinical presentations. Until now, there is no consensus concerning the most effective treatment for spondyloptosis. Satisfactory clinical and good outcomes can be obtained by anterior cervical corpectomy and fusion.

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

Cervical spondyloptosis is a serious condition scarcely encountered by spine surgeons. Few cases have been reported in the literature. There are no general guidelines for their management, especially in delayed cases. The authors describe their surgical technique for the management of cervical spondyloptosis 45 days after the trauma. A 28-year-old patient was admitted 45 days after head and cervical trauma leading to quadriplegia with muscular strength at the C5 level. Cervical computed tomography scanning and magnetic resonance imaging revealed C6-7 spondyloptosis with complete slippage of the C6 vertebral body in front of C7. Posterior and anterior cervical spine approaches during the same surgery allowed decompression and stabilization, leading to a dramatic improvement in the neurological deficit. The patient was able to walk 18 months later with near normal balance. Traumatic cervical spondyloptosis requires early management to increase the possibility of decompression through anatomical realignment and stabilization. In delayed cases, a combined anterior and posterior cervical spine approach according to our technique allows decompression and stabilization with a good postoperative outcome possible.

Application of “key and lock” principle in the treatment of traumatic cervical Spondyloptosis of c6-7: Case report and literature review

Purpose: Traumatic cervical spondyloptosis is a rare clinical pathology that often causes complete paralysis. When a patient presents neurologically intact or incomplete paralysis, the management becomes more complicated. Preservation of neural function and restoration of anatomic alignment collectively remain the golden goals of therapy. There are still few reports on this issue, however, the existing literature did not clearly define severity of injuries and the treatment strategy in such cases. On the occasion of reporting one treated traumatic C6-7 spondyloptosis case, we reviewed existing literatures. Material and Methods: The patient was a 48-year-old man who had motorcycle accident and was presented with post-operation for right frontal epidural hematoma in 3 days before admitting to hospital. Neurological assessment showed motor strength grade 3/5 in the proximal upper and lower-extremity muscle groups on the right side, and 1/5 on the left side with incontinence of sphincters. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with complete anterior displacement of C6 to C7 vertebral body. We applied the “Key - Lock” principle for better understanding of the biomechanics of the injury and found out the favorable strategy. The patient underwent posterior approach with decompression and anterior approach with reduction and anterior cervical discectomy fusion for C6-7. Results: After 8 months follow-up, the patient had recovered muscular strength in bilateral upper and lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate by himself. Plain radiograph and CT scan showed good aligment and progressive maturation of his fusion procedure. Conclusion: Traumatic cervical spondyloptosis of C6-7 is a high-energy unstable fracture and rare. This report develops a new principle called “Key and Lock” for more understand the biomechanics of the injury and treatment. Our patient was successfully treated with open reduction, decompression, and anterior cervical discectomy fusion.

Application of "key and lock" principle in the treatment of traumatic cervical Spondyloptosis of c6-7: Case report and literature review

Application of "key and lock" principle in the treatment of traumatic cervical Spondyloptosis of c6-7: Case report and literature review

Traumatic cervical spine spondyloptosis: A systematic review.

Background:Spondyloptosis is a rare presentation of cervical spine traumatism where listhesis is more than 100%. Traumatic cervical spine spondyloptosis (TCS) is one of the least discussed forms of cervical spine traumatisms because of its rarity and the gravity of patient's condition, limiting good management, and the number of reported cases.Objectives:This study aimed to discuss clinical, radiological, and best management tools of the aforementioned pathology.Materials and Methods:Scopus, ScienceDirect, PubMed, and Google Scholar databases were searched for English articles about traumatic cervical spondyloptosis. Titles, abstracts, or author-specified keywords that contain the words “spondyloptosis” AND “cervical” AND “spine” were identified. There were no time limits. In sum, 542 records were identified, 63 records were screened, and 46 records were included in this review, describing 64 clinical cases of traumatic cervical spondyloptosis. The clinical cases of two patients managed at our department are also presented and included. In the end, 66 cases were included in this study. Demographics, clinics, radiology, management tools, and outcome of the reviewed cases were discussed. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2009. The American Spinal Injury Association Impairment Scale (AIS) score was used to evaluate the clinical presentations.Results:This review included 66 patients consisting of 46 males (70%) and 20 females (30%), with a mean age of 41 years. The accident was indicated in 62 cases; it was a road traffic accident in 29 cases (46%), a fall in 24 cases (38%), and motor vehicle accident in 15 cases (24%). The lesion was iatrogenic in four patients. Twenty-one patients were received without motor or sensitive deficit and so scored Grade E on AIS, 10 with Grade D, 11 Grade C, four Grade B, and 20 with Grade A. On imaging, spondyloptosis involved the C1–C2 segment in two cases (3%), C2–C3 in three cases (5.5%), C3–C4 in one case (1.5%), C4–C5 in six cases (9%), C5–C6 in nine cases (13%), C6–C7 in 20 cases (30%), and C7–T1 in 26 cases (38%). In all cases, there was either fracture or dislocation in posterior elements. Bilateral pedicles or facet joint fractures were noted in 53% of the 56 patients where the associated lesions were described, but it jumps to 89% when a vertebra is projected in front of another. In two cases, there was no mention of closed reduction via transcranial traction; in 13 cases (20%), it was avoided for a reason (child, patient's refusal,…). In the 51 cases where the traction was clearly applied, 17 cases (33%) were reduced totally; in 13 cases (25%) the reduction was partial; it failed in 19 cases (37%); and in the remaining cases, the result was not clear. Traction weight varied from 4 kg to 27.2 kg, applied from 6 h to 20 days. Where total reduction was achieved, an average weight of 11.9 kg with proximal average time of 6 days was needed, whereas an average of 11.5 kg was needed for partial reduction with proximal average time of 10 days. 62 patients were operated rather in one or two times. Anterior approach was used in 20 patients (32%), a posterior approach in 14 patients (23%), and combined anterior/posterior approaches in 28 patients (45%). In four patients, the outcome was not available; in the remaining 62 cases, an improvement of an initial deficit was noted in 25 patients (40%), conservation of an initial motor force integrity was noted in 19 patients (30%), and nine patients (14.5%) kept the same initial deficit. Few complications were declared: dura tears with cerebrospinal fluid leaks, meningitis, esophageal laceration, and vocal cord paralysis. There was a mortality of 11% (seven cases).Conclusion:Traumatic cervical spine spondyloptosis predominates in the lowest levels of the cervical spine, allowed in all cases by a failure in posterior elements. It is a lesion with the worst clinical presentation. Traumatic cervical spine spondyloptosis is highly instable, imposing urgent reduction followed by surgical stabilization. At the limit of the reviewed cases, outcome is in general good, but mortality is still important.

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

Background and Importance: Traumatic cervical spondyloptosis is a rare and severe situation, i.e., associated with disabling neurological deficits. Case Presentation: We described an unusual clinical presentation of cervical spondyloptosis in a 49-year-old man without neurological impairment and severe neck pain. Moreover, C6-C7 spondyloptosis was assessed two days after the trauma. X-rays, Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) demonstrated a C6 bi-pedicular fracture, C6-C7 facet dislocation with complete ptosis of C6 vertebral body over C7 and without spinal cord injury. The patient was managed with an intra-operative 4 Kg traction and underwent a posterior decompression, with reduced fracture/dislocation by bilateral completed facetectomies at C6, and fusion from C4 to T3. Conclusion: This case report emphasized that sometimes cervical spondyloptosis may occur without neurological deficit symptoms. Prompt clinical recognition and surgical removal are essential to prevent serious complications in this respect.

Management of Traumatic Cervical Spondyloptosis

AbstractTraumatic cervical spondyloptosis is a 3-column fracture-dislocation resulting in a highly unstable spine requiring urgent reduction, stabilization, and fixation. Since its occurrence is not that common, there are a lot of controversies concerning its management. A holistic approach has been proposed regarding the management of traumatic cervical spondyloptosis.

Traumatic Cervical Spondyloptosis: Review of Literature and Case Report

Traumatic Cervical Spondyloptosis: Review of Literature and Case Report

Traumatic spondyloptosis at the cervico-thoracic junction without neurological deficits.

Background:There have been rare cases of traumatic cervical spondyloptosis without neurological compromise. We report another case and provide a review of the literature, with a focus on appropriate management.Case Description:A 60-year-old male rode his bicycle into a stationary semi-truck. He reported initial bilateral upper extremity paresthesias that resolved. Imaging demonstrated C7 on T1 spondyloptosis. Traction did not achieve reduction and a halo was applied. Subsequently, he underwent posterior decompression C6-T1, reduction via bilateral complete facetectomies at C7, and fixation from C4 to T2 fixation. Afterward, an anterior C7-T1 fixation occurred, where exposure was performed through a midline sternotomy. Postoperatively, he woke up with baseline motor and sensory examination in his extremities. He did exhibit voice hoarseness due to paralysis of the left vocal cords. He was discharged home 3 days after surgery. At 6 months follow-up, there was a progressive improvement of the left vocal cords to slight paresis; dynamic X-rays demonstrated no instability with good fusion progression.Conclusion:Traumatic cervical spondyloptosis without neurological compromise is a rare and challenging scenario. There is a concern for neurologic compromise with preoperative traction, but if specific posterior elements are fractured, the spinal canal may be wide enough where the concern for disc migration is minimal. For patients who have not been reduced preoperatively, a posterior approach with initial decompression to widen the canal, before reduction, appears safe. This scheme may avoid an initial anterior approach for decompression, necessitating a 3-stage procedure if circumferential stabilization is pursued.

Traumatic Cervical Spondyloptosis of the Subaxial Cervical Spine: A Case Series with a Literature Review and a New Classification.

Study DesignThis is a retrospective study on patients with traumatic subaxial cervical spondyloptosis and includes a review of the available literature regarding the management of this injury.PurposeThis study aimed to assess the biomechanics and varied clinical presentations of this rare but devastating injury.Overview of LiteratureThis is a case series of three patients and a review of the available literature on subaxial cervical spondyloptosis. Traumatic cervical spondyloptosis of the subaxial spine is rare, with varied clinical presentations.MethodsThe management of cervical subaxial spondyloptosis represents a challenge to all spine care specialists, and there is a paucity of literature on the best methods for managing this condition. Our experience includes three such patients who visited our tertiary trauma center. This article explains the diverse clinical features of the injury as well as the management of these patients and includes a review of the available literature.ResultsSubaxial cervical spondyloptosis is a devastating injury with diverse clinical features. We present a classification of these fractures based on clinical presentation and magnetic resonance imaging results, which can help in decision-making regarding the management of such patients.ConclusionsThis article may help physicians assess this injury in an evidence-based manner and also elucidates the management strategies available for such patients.

Traumatic Cervical Spondyloptosis in a Neurologically Stable Patient: A Therapeutic Challenge.

This is a case report of a neurologically intact patient following posttraumatic cervical spondyloptosis. We discuss the disease, management protocol and some surgical nuances to prevent any damage to the cord during different stages of its treatment.

Significant neurologic recovery after traumatic cervical spondyloptosis and spinal cord injury

Significant neurologic recovery after traumatic cervical spondyloptosis and spinal cord injury

A novel case of “ambulatory” cervical spondyloptosis: case report with literature review

Cervical spondyloptosis is an extreme variant of cervical spinal injury where patients usually present with disabling neurological deficits. Presentation of these patients without significant morbidity is very rare and we could only find sporadic case reports in literature involving traumatic cervical spondyloptosis without neurological deficits. Usually such patients get spared due to expansion of spinal canal after fracture of posterior vertebral elements. We report a case of traumatic C5/C6 spondyloptosis in an ambulatory patient despite having an intact posterior vertebral arch. This patient was managed successfully with anterior cervical fusion. To the best of our knowledge, this is the first case report of its kind as it exemplifies the rarity of such an occurrence and underlines the importance of timely management to maintain such preserved neurological status.

Basilar artery thrombosis after reduction of cervical spondyloptosis: a cautionary report

Traumatic cervical spondyloptosis is a rare clinical entity typically associated with complete neurological deficit. The inherent mechanics of this fracture-dislocation pattern contorts the vertebral arteries in such a way that it may result in dissection or compromised flow through those vessels. Thus, intimal injury or thrombus from stasis of flow may result. Reduction of the spondyloptosis restores flow to the vertebral arteries, but it also may mobilize thrombus or propagate an intimal dissection within the previously contorted vessel. The authors review their experience in the care of a 43-year-old man who sustained C4-5 spondyloptosis while riding an all-terrain vehicle. On arrival, the patient demonstrated no motor function below C-4 but had sensation to the nipple line (American Spinal Injury Association Spinal Cord Injury Classification B). The patient's cranial nerve examination was unremarkable. Computed tomography of the cervical spine demonstrated complete spondyloptosis at C4-5. The patient was immediately placed in cervical traction and taken to the operating room for open reduction of the fracture dislocation, decompression of the spinal cord, and stabilization with an interbody graft and cervical plate. Preoperative cervical traction was successful in only partial reduction of the fracture dislocation. Open reduction was achieved with exposure of the C-4 and C-5 bodies and sequential distraction. After anatomical alignment was achieved, an interbody graft was placed and a cervical plate secured. A subsequent decline in the patient's level of consciousness prompted CT of the head, which showed evidence of a basilar artery thrombosis. A CT angiographic study demonstrated patency of the vertebral arteries, but a mid-basilar artery thrombosis. The patient progressed to brain death 24 hours after reduction of the fracture dislocation. The degree of contortion of the vertebral arteries in cervical spondyloptosis in the upper cervical spine may result in stasis of flow with subsequent formation of thrombus or intimal injury. After anatomical reduction, restoration of flow within the vertebral arteries may mobilize the thrombus or propagate an intimal dissection and result in subsequent embolic events. Endovascular evaluation may be warranted immediately after anatomical reduction of a high cervical spondyloptosis for evaluation of the vertebral arteries and possible thrombus dissolution or retrieval.

Management of Traumatic Cervical Spondyloptosis in a Neurologically Intact Patient

Case report. To review the management of a neurologically intact patient with complete cervical spondyloptosis with particular attention to the role and timing of closed preoperative cervical traction and subsequent stabilization. Traumatic cervical spondyloptosis is typically associated with complete and irreversible spinal cord injury. In these patients, cervical traction can be implemented to restore anatomic alignment in preparation for stabilization with minimal consequence. When a patient presents neurologically intact, the management becomes more complicated. Preservation of function and restoration of anatomic alignment collectively represent the goals of therapy. The current literature does not clearly define the role of cervical traction in such cases. A patient with traumatic cervical spondyloptosis at the C7-T1 level presented to our institution and was found to be neurologically intact. Computed tomography demonstrated complete spondyloptosis with multiple fractures through the posterior elements. The spondyloptosis was reduced with closed cervical traction and underwent anterior and posterior instrumented stabilization. No new deficit occurred in the patient after reduction. Fractures of the posterior elements functionally decompress the spinal canal and thereby allow for cervical traction to be safely implemented in patients with spondyloptosis. Safe restoration of anatomic alignment in the neurologically intact spondyloptotic patient is crucial to minimize the extent of surgical stabilization and create a long-term stable construct of the fracture dislocation.

Post-traumatic c7-t1 spondyloptosis in a patient without neurological deficit: a case report

Traumatic cervical spondyloptosis has almost always been associated with disabling neurological deficit and we could only find one case without a neurological deficit reported in the literature. A 42 year old man suffering from severe neck pain following a high speed motor vehicle accident was admitted to our hospital. Magnetic resonance imaging (MRI) and computerized tomography (CT) of the cervical spine and neurologic examination of the patient were performed. The patient was treated with three-column fixation of the traumatic level. We aimed to report a unique case of traumatic C7-T1 total spondyloptosis without a neurological deficit and discuss possible mechanisms and treatment modalities.