Cervical Spondyloptosis Successfully Treated with Only Posterior Short Segment Fusion Using Cervical Pedicle Screw Fixation

Abstract

This paper describes two patients with cervical spondyloptosis with severe spinal cord injury treated with cervical pedicle screw (CPS) through a single-stage operation, posterior approach. A 60-year-old male patient with quadriparesis due to trauma 1 day before visited the emergency room. Cervical spine computed tomography (CT) and magnetic resonance imaging showed complete dislocation of the C7 and T1 vertebrae with severe spinal cord compression, disc injury, and disc herniation at the C7–T1 level. Cervical pedicle screw with freehand technique was done on C6 and T1 vertebrae, and bilateral distraction for a reduction was performed with a screw distractor. After reduction of the C7 vertebra on the surgical field, CPS placement on C7 body was done. After surgery, follow-up X-rays showed near complete reduction. The patient completed a rehabilitation program, and his condition improved. From the third month postoperatively, the patient could ambulate without assistance and perform nearly normal daily activities. A postoperative CT scan 1 year later showed accurate screw position and complete fusion bridges on the C6–C7–T1 vertebrae. The other patient, a 39-year-old male, also showed C7–T1 spondyloptosis with quadriparesis (grade IV). C6–T1–T2 fusion surgery was performed only through a posterior approach. The patient showed nearly normal neurology and reduction. Considering early surgery time followed by open reduction and biomechanical superiority of CPS, single posterior approach and short segment fusion appear to be a great surgical method.

Traumatic cervical spine spondyloptosis

“…Kim et al . [ 7 ] reported a case of TCS caused by rehabilitation in a patient with initial bilateral facet locking operated few days before. In another case, Oppenlander et al .…”

Management of Traumatic Cervical Spondyloptosis with an Unsealable Dura Tear: A Case Report

“…It results in complete disruption of the structural elements of the vertebral column and the adjacent paravertebral soft tissue, culminating in intense biomechanical instability. 3 4 5 6 14 15) According to the 3-column model of spinal trauma, fracture dislocation injuries are the most unstable fractures and have the strongest association with spinal cord injury of all fracture types. 9) Besides this type of high-energy trauma, the condition can also result from birth trauma, congenital anomaly, inflammation and infection, and neoplastic conditions.…”

“…Spondyloptosis is complete fracture dislocation and subluxation in the coronal or sagittal plane defined as grade V spondylolisthesis. 3 4 5 6 15) It is very rare, but when it does occur, severe neurological deficits are common due to transection of the spinal cord. 9 10) It usually results from birth trauma, congenital anomalies, neoplastic disease and high-energy injury.…”

Low-cost 3D Modeling Software for Generating Patient-specific Drill Guide Templates for Cervical Pedicle Screw Insertion: An In Vitro Study

“…1,2 Literature shows that in instrumented posterior cervical spine surgeries (IPCSS), cervical pedicle screws (CPS) offer greater stability than lateral mass screws. [3][4][5][6][7] Different methods are used to ensure proper CPS placement. In the free-hand technique, a long learning curve is required and the user must have expertise in analyzing preoperative images and determining anatomic landmarks.…”