Introduction: Most reports of spondyloptosis describe fractures occurring at the lumbosacral junction or in the cervical spine. Complete dislocation at the thoracolumbar junction is a rare occurrence with only four previously described cases in three series. Surgical procedures in the reported cases of spondyloptosis at the thoracolumbar junction have been described using instrumentation, reduction, decompression and stabilization techniques. We describe a case of thoracolumbar spondyloptosis with surgical reconstruction without the use of leveraged instrumented reduction. In this report we describe a single stage, posterior only spinal realignment, reconstruction, and stabilization.
Methods: A single stage posterior decompression and reconstructive surgery was performed. The decompression included an L1 laminectomy with a complete vertebrectomy. The entire L1 vertebral body was harvested for autograft. An intraoperative CT was obtained to verify the final anatomical vertebral column alignment following positioning on the Jackson operating room table. O-arm navigation was employed to enhance the placement of pedicle screw placement. The construct included pedicle screw placement at T8-T12 bilaterally and L2-L4 bilaterally. L1 was not instrumented, as it was completely removed and used for autograft reconstruction.
Results: Clinically, the patient had a remarkably uneventful hospital course. Fortunately, he did not experience any of the complications that frequently accompany complete spinal cord injury, such as pneumonia, decubitus ulcers, or deep-venous thrombosis. He was discharged to a rehab facility one week after the operation where he learned how to independently transfer to a wheelchair and navigate his surroundings. Within months of therapy, he enrolled and attended courses at a local college and regained personal independence by learning to drive a motor vehicle with a hand control.
Conclusions: Traumatic spondyloptosis at the thoracolumbar junction is a surgical condition that must be addressed with reconstruction of the spinal column with instrumentation techniques. The use of a complete vertebrectomy to assist in realignment offers an additional technique that lessens the risk to surrounding vital structures and decreases instrumentation stress incurred in standard reduction techniques. Reconstruction with local autograft and long-segment instrumentation are viable techniques to provide axial stability and maintain sagittal alignment.
Patient Care: Increase awareness of various surgical options for treating spondyloptosis at the thoracolumbar junction
Learning Objectives: Discuss spinal reconstruction options and considerations with traumatic spondyloptosis