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

Mamindla, Ravi Kumar; Kumar, Ashish; Bhattacharjee, Suchanda; Sahu, Barada Prasad

doi:10.1007/s00586-013-2827-0

Cited by 12 publications

(12 citation statements)

References 13 publications

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“…[315] However, it is most commonly caused by trauma attributed to motor vehicle accidents or falls. [67] Here, we reviewed the literature and reported a case of C5–6 spondyloptosis associated with quadriplegia treated with an anterior-only approach.…”

Section: Introductionmentioning

confidence: 99%

Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends

Wong¹,

Chang²,

Monasky³

et al. 2017

Surg Neurol Int

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Background:Cervical spondyloptosis is defined as the dislocation of the spinal column most often caused by trauma. Due to compression or transection of the spinal cord, severe neurological deficits are common. Here, we review the literature and report a case of traumatic C5–6 spondyloptosis that was successfully treated using an anterior-only surgical approach.Methods:The patient presented with quadriplegia and absent sensation distal to the C5 dermatome following a rollover motor vehicle accident. The preoperative American Spinal Injury Association Impairment Scale was A. Computed tomography of the cervical spine revealed C5–6 spondyloptosis, lamina fractures on the right side at the C3–4 level, and widened facet joint on the right side at C6–7.Results:The patient underwent cervical traction and anterior cervical discectomy and fusion at the C5–6, C6–7 levels; no 360° fusion was warranted. Six months postoperatively, the patient remained quadriplegic below the C5 level.Conclusion:Presently, no consensus is present regarding the best treatment for spondyloptosis. Worldwide, the 360° approach is the most commonly used (45%), followed by anterior-only surgery (31%) and posterior-only surgery (25%). The surgical choice depends upon patient-specific features but markedly varies among geographical regions.

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Section: Introductionmentioning

confidence: 99%

Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends

Wong¹,

Chang²,

Monasky³

et al. 2017

Surg Neurol Int

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“…Spondyloptosis is a term for spinal dislocation or Grade V spondylolisthesis, in which one vertebral body is lodged in the anterior or posterior space of the other one9,10). It is more common in the lumbar spine than in the cervical spine, and can be seen following birth trauma3), and congenital conditions2,13) of the cervical spine like absent cervical pedicles, corticated defect in pars interarticularis and neoplastic diseases7) like neurofibromatosis or aneurysmal bone cyst and after vehicle or diving trauma1).…”

Section: Discussionmentioning

confidence: 99%

Management of Traumatic C6-7 Spondyloptosis with Cord Compression

Choi

Kim

et al. 2014

J Korean Neurosurg Soc

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A case of total spondyloptosis of the cervical spine at C6-7 level with cord compression is described in a 51-year-old male. Because the bodies of C6 and 7 were tightly locked together, cervical traction failed. Then the patient was operated on by a posterior approach. Posterior stabilization and fusion were performed by C4-5 lateral mass and C7-T1 pedicle screw fixation and rod instrumentation with bridging both C4-5's rods to the C7-T1's extended ones. After C6 total laminectomy and foraminotomy, the C6 body was returned to its proper position. Secondly, anterior stabilization and fusion were performed by C6-7 discectomy with a screw-plate system. A postoperative lateral plain radiograph showed good realignment. In this case, we report the clinical presentation and discuss the surgical modalities of C6-7 total spondyloptosis and the failed close reduction.

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“…The most accepted approach is the combined anterior and posterior 360º or 540º, with or without corpectomies. This approach provides wide canal decompression and successful cervical spine realignment (1)(2)(3)(4)(5)(6)(7)(10)(11)(12)(13). Additionally, the management of chronic spondylisthesis would have some considerations according to our experience.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Case Reportmentioning

confidence: 99%

“…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)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(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.…”

Section: Case Reportmentioning

confidence: 99%

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

et al. 2017

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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...

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

Abstract: 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.

Cited by 12 publications

References 13 publications

Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends

Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends

Management of Traumatic C6-7 Spondyloptosis with Cord Compression

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

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