Irreducible L5/S1 Spondyloptosis in Over 20 Years After Neglected Trauma Treated with Modified Grob’s Technique – Case Report

Abstract

Introduction Spondyloptosis, characterized by complete slippage of the upper vertebral body relative to the lower vertebral body, is an exceedingly rare condition. Typically, it occurs as a result of a high-energy injury and is promptly managed. It is uncommon for a patient to present to a spinal surgery unit several decades after the initial incident. Case Report In this case report, we describe the case of a 62-year-old man who experienced a lumbosacral injury from a fall twenty years prior to seeking treatment. The patient had multiple comorbidities, including obesity and internal medicine conditions. He presented with severe back pain radiating to the lower extremities, accompanied by significant neurogenic chroma and lower extremity weakness. Imaging studies revealed spondyloptosis at the L5/S1 level, along with bony fusion and spinal canal stenosis at the L3/L4 level. Conclusion The patient underwent surgical intervention using Grob’s direct pediculo-body fixation technique. The postoperative period was uneventful, and over the course of one year of follow-up, the patient experienced a resolution of symptoms and significant improvement in functional capacity.

Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal

“…7 This mostly often occurs in the transitional spinal regions (C7-T1, T10-L2, L4-S1 and L4/L5). 1,7 Furthermore there is least resistance along the first sacral vertebral foramen. 6 Cervical spondyloptosis harbinger risk of injuries to the phrenic nerve and vertebral artery.…”

“…3 There are currently no clear guidelines for the management of traumatic spondyloptosis. 1 Distraction, unlocking, anatomic fixation, and arthrodesis are the dictum of surgical management. 6 The core principle of care is restoration and stabilization of spinal alignment to facilitate early mobilization and rehabilitation in the patient.…”

“…3 Grob's, Gaines and Nichols methods have significant surgical risks. 1 Furthermore, pelvic instrumentation may be justified to prevent pseudo-arthrosis. 1 Therefore standalone long-segment posterior instrumentation is often the 'work-horse' in the surgical management of thoracic and lumbar spondyloptosis, especially in ASIA 'A' and 'B' subtypes', to facilitate their rehabilitative strategies.…”

“…1 Furthermore, pelvic instrumentation may be justified to prevent pseudo-arthrosis. 1 Therefore standalone long-segment posterior instrumentation is often the 'work-horse' in the surgical management of thoracic and lumbar spondyloptosis, especially in ASIA 'A' and 'B' subtypes', to facilitate their rehabilitative strategies. 3 Standalone anterior or posterior approaches may be justified in cervical spondyloptosis with similar neurological status depending upon the reducibility of the subluxation after traction.…”

“…Meyerding first described spondyloptosis in 1938. 1 This is the most severe and unstable variant of translational injury that can that invariably leads to complete cord transection (above 70% cases) and ominous to permanent neurological deficits. 2 The survivors are compelled to be dependent on others for lifelong even for carrying out their activities of daily living (ADLs).…”