Surgical management of traumatic thoracic spondyloptosis: Review of 2 cases

Sekhon, Lali H.S.; Sears, William; Lynch, James J.

doi:10.1016/j.jocn.2006.03.003

Cited by 25 publications

(48 citation statements)

References 17 publications

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“…Motor vehicle accidents and substantial falls, with their capability to induce considerable shear forces, are the most frequent causes of traumatic spondyloptosis. 9,10,13,16,18 Biomechanically, the mechanism of double-level spondyloptosis in this particular patient was most likely to have been a severe shear force in the anteroposterior direction combined with hyperextension, with complete discoligamentous disruption occurring at the T2-3 intervertebral disc, resulting in complete posterior dislocation of the T-1 and T-2 vertebrae with respect to the T-3 and T-4 vertebrae. Eventually, descent of the cranial vertebrae had cut off the pedicles of the lower vertebrae from their bodies, resulting in free-floating posterior arches, hence permitting the free descent and relocation of the T-1 and T-2 vertebral bodies in the posterior aspect of the T-3 and T-4 vertebral bodies.…”

Section: Discussionmentioning

confidence: 92%

“…1,4,9,10,13,16,18,21,22 In sagittal-plane spondyloptosis, the upper vertebral body is usually located anterior to the caudal vertebra, whereas lateral and posterior spondyloptosis have been sparsely reported.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,6,[8][9][10][12][13][14][15][16][17][18] Under certain rare circumstances, however, despite significant anterior-posterior or lateral displacement, the patient can remain neurologically intact or be only mildly affected. 9,10,12,14,17,18 The reason for such neural sparing is quite interesting because a great discrepancy exists between the spectacular radiological features and the neurological picture.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,6,8,13,15 However, surgery in patients with intact neural function is an extremely challenging process, particularly in those with normal neurological function, in whom preservation of neurological integrity is paramount. 1,4,9,10,12,14,[16][17][18][20][21][22] In such instances, surgical intervention should be carried out under neuromonitoring to avoid further injury to the spinal cord. However, in paraplegic patients with spondyloptosis, the foremost goal is stabilization after reduction and alignment, surgical interventions that allow early mobilization and rehabilitation with a wheelchair.…”

Section: Discussionmentioning

confidence: 99%

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Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

Rahimizadeh

2015

SPI

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Traumatic spondyloptosis of the thoracic spine is an uncommon injury. In most cases, spondyloptosis is confined to one vertebral body, whereas double-level spondyloptosis is extremely rare. Most patients who sustain traumatic spondyloptosis immediately become paraplegic, but in some cases neurological function is preserved. If this occurs, it is due to detachment of the pedicles from the corresponding vertebral body, resulting in spontaneous decompression of neural elements. Herein, the authors describe a case of undetected traumatic double-level spondyloptosis in the upper thoracic region in an adult male patient who was neurologically intact for 2 days but later became paraplegic. Initially, management of this pathology seemed a very challenging scenario. However, with review of the reconstructed CT images and reproduction of the injury on a plastic model, a posterior-only approach was chosen as an alternative operative solution for this catastrophic injury. Via this single-stage posterior approach, long-segment pedicle screw/rod instrumentation resulted in successful reduction, restoration of alignment, and stabilization after 1-level posterior spondylectomy. To the best of the authors’ knowledge, this is the first example reported in the literature of double-level spondyloptosis of the thoracic and the lumbar spine. This report describes the rationale, mechanism, and technical details afforded for reduction and stabilization of this rare injury.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

Rahimizadeh

2015

SPI

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“…Nevertheless, fractures/dislocations of the thoracic and lumbar spine are rare, accounting for less than 3% of all spinal injuries (6). Few cases have been reported (32,39,42). Severe spinal fracture/dislocation is defined as fracture combined with greater than 50% displacement of one vertebra in the coronal or sagittal plane (25).…”

Section: Introductionmentioning

confidence: 99%

Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series

Xiong

Li²,

Zhang³

et al. 2012

Turkish Neurosurgery

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AIm: This study reports a technique for treating severe thoracolumbar fractures with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach. mAterIAl and methOds:The cases of 11 patients with severe traumatic thoracolumbar fractures/dislocations that were managed with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach were included. Data on age, sex, mechanism of injury, associated trauma, neurological status, surgical technique, and clinical outcome were reviewed retrospectively. results: Of the 11 patients, two presented with primarily coronal displacement and nine with sagittal displacement. Coronal displacement was corrected from 19% preoperatively to 4.0% at the last follow-up evaluation. Sagittal displacement was reduced from 73.0% preoperatively to 3.0% at the last follow-up evaluation. After a mean follow-up period of 20.7 (range 16-30) months, no patient complained of local pain and no significant loss of correction or hardware failure was observed.COnClusIOn: Our experience proves that the single-stage posterior approach is safe and biomechanically reliable for treating severe thoracolumbar fractures/dislocations. Therefore, the presented technique is an alternative approach for this rare injury.KeywOrds: Thoracolumbar fracture, Severe dislocation, Single-stage, Posterior approach ÖZ AmAÇ: Bu çalışma, tamamen posterior bir yaklaşımla tek evreli dekompresyon, redüksiyon, rekonstrüksiyon ve stabilizasyon ile şiddetli torakolumber kırıkları tedavi etmek için bir tekniği bildirmektedir. yÖntem ve GereÇler: Tamamen posterior yaklaşımla tek evreli dekompresyon, redüksiyon, rekonstrüksiyon ve stabilizasyonla tedavi edilen şiddetli travmatik torakolumber kırık/dislokasyonu olan 11 vaka dahil edilmiştir. Yaş, cinsiyet, yaralanma mekanizması, ilgili travma, nörolojik durum, cerrahi teknik ve klinik sonuçlarla ilgili veriler retrospektif olarak gözden geçirilmiştir.BulGulAr: 11 hasta içinde ikisi primer koronal displasman ve dokuzu sajital displasmanla gelmiştir. Sajital displasman preoperatif olarak %19'dan son takip değerlendirmesinde %4,0'a düzeltilmiştir. Sajital displasman preoperatif olarak %73,0'dan son takip değerlendirmesinde %3,0'a düzeltilmiştir. Ortalama 20,7 (aralık 16-30) aylık takip süresiyle hiçbir hasta yerel ağrıdan yakınmamış ve düzeltmede önemli bir kayıp veya donanımla ilgili başarısızlık gözlenmemiştir. sOnuÇ: Deneyimimiz tek evreli posterior yaklaşımın şiddetli torakolumber kırıklar/dislokasyonlar tedavisinde güvenli ve biyomekanik olarak uyumlu olduğunu göstermiştir. Bu nedenle sunulan teknik bu nadir yaralanma için alternatif bir yaklaşımdır.

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Traumatic retropulsion of T10 vertebra in a 5-year-old boy with involvement of neurocentral synchondrosis: a case report and review of the literature

2013

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Surgical management of traumatic thoracic spondyloptosis: Review of 2 cases

Cited by 25 publications

References 17 publications

Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series

Traumatic retropulsion of T10 vertebra in a 5-year-old boy with involvement of neurocentral synchondrosis: a case report and review of the literature

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