Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center

Abstract

Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.

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

“…5 This can be anterior (almost 80%), posterior, or lateral relative to the caudal vertebra depending upon the direct of the impact, as described by Denis and Burkus. 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.…”

Management of traumatic sacral spondyloptosis: illustrative case

“…Observations Spondyloptosis is a complication of high-energy trauma that typically occurs at the lumbosacral junction following a fall from a height or a road traffic accident. 1,2 Sagittal plane spondyloptosis is more common than coronal plane spondyloptosis. 1 Sacral intersegmental spondyloptosis in adults is extremely rare because fusion of the five sacral segments should be complete before the third decade of life.…”

“…5 Early intervention and complete realignment should be prioritized to prevent the progression of compressive nerve damage and limit residual listhesis, because duration of injury is associated with postoperative residual listhesis, and residual listhesis is associated with postoperative nociceptive and neuropathic pain. 1…”

“… 1 , 2 Sagittal plane spondyloptosis is more common than coronal plane spondyloptosis. 1 Sacral intersegmental spondyloptosis in adults is extremely rare because fusion of the five sacral segments should be complete before the third decade of life. 3 Three other cases of an adult with sacral spondyloptosis have been reported in the literature, only one of which was treated surgically.…”

“… 4 However, spondyloptosis with neural sparing is extremely rare, and realignment may or may not lead to partial recovery of function. 1 , 6 Mishra et al 2 reported a case of spondyloptosis of S1 over S2 with a concomitant burst fracture at L2 in a 27-year-old female following a car accident, resulting in complete paraplegia. The patient did not wish to undergo surgery for spondyloptosis and was operated on only for an associated L2 burst fracture, and no neurological function was recovered prior to hospital discharge or during the follow-up period.…”