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  • A case of traumatic coronal spondyloptosis; review of literature and appropriate operative management

    Final Number:
    4107

    Authors:
    Anand Kaul MD; Rafeed Al Drous; Bong-Soo Kim MD, MS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: Traumatic Coronal Spondyloptosis (TCS) is defined as greater than 100% subluxation of vertebral body over another in the coronal plane. It represents a rare type of spinal fracture dislocation generally secondary to high energy impact and it has a common association with injury to intraabdominal or thoracic organs which often complicates management. There are currently no standardized guidelines for the management of this severe traumatic injury.

    Methods: We present a case of thoracolumbar (TL) junction TCS, discussing the surgical technique used for reduction, deformity correction, stabilization and fusion, and reviewing the techniques used for reduction of similar reported cases.

    Results: Our presented case with TLTCS was expertly managed with manual caudal reduction and the use of hand held clamps. The patient was positioned prone on gel rolls with pelvic corset applied in anticipation of intraoperative augmentation of traction. The patient was given ample muscle relaxant perioperatively. Pedicle screws were placed 3 levels above and below thoracolumbar junction and fixated with temporary rods. Complete reduction was achieved with manual caudal reduction and drilling of intervening right T12-L1 facet joint. Following reduction, the installation of permanent rods and cross links with decortication of bone was performed to enhance posterolateral fusion.

    Conclusions: Our patient had ASIA A spinal cord injury preoperatively, thus we were able to utilize muscle relaxant medication to help facilitate reduction of deformity. In patients with residual neurological function, however, neuro monitoring is required which limits the use of muscle relaxant and increases the difficulty of vertebral body distraction. Therefore, reduction can completed with use of distraction instrumentation. If reduction requires high magnitude of distraction, a vertebrectomy of the dropped vertebra will shorten the spine and can facilitate reduction more safely. Understanding the variety of surgical options in operative management of TCS is critical in the correction of this debilitating and unstable injury.

    Patient Care: These authors believe that the thought process of planning surgical intervention and possible alternatives is an important exercise in operative management of complex disease. The provided case report and review of the literature provides an overview of the various management strategies available for neurosurgeons who may look for guidance in the management of this complex, destabilizing and potentially neurologically devastating injury.

    Learning Objectives: 1. Understand the mechanism of action of traumatic coronal spondyloptosis and its range of neurological sequalae 2. Appreciate the variety of surgical methods for reduction and stabilization of TCS and the nuance of when these options are viable

    References: 1. Akay KM, Baysefer A, Kayali H, Beduk A, Timurkaynak E: Fracture and lateral disloca- tion of the T12-L1 vertebrae without neuro- logical deficit – Case report. Neurol Med Chir (Tokyo) 2003;43:267–270. 2. Cherian I, Dhawan V. Lateral lumbar spondyloptosis. Int J Emerg Med. 2009;2:55-56. 3. Evans LJ. Images in clinical medicine. Thoracolumbar fracture with preservation of neurologic function. N Engl J Med 2012;367:1939. 4. Garg, M., Kumar, A., Sawarkar, D. P., Singh, P. K., Agarwal, D., Kale, S. S., & Mahapatra, A. K. (2018). Traumatic Lateral Spondyloptosis: Case Series. World neurosurgery, 113, e166-e171. 5. Guzel A, Belen D, Tatli M, Simsek S, Guzel E. Complete L1-L2 lateral dislocation without fracture and neurologic deficit in a child.Pediatr Neurosurg. 2006;42(3):183–186. 6. Hsieh CT, Chen GJ, Wu CC, et al. Complete fracture-dislocation of the thoracolumbar spine without paraplegia. Am J Emerg Med. 2008;26:e5–e7. 7. Morel E, Ilharreborde B, Zadegan F, Dauzac C, Rillardon L, Guigui P. Thoracolumbar junction lateral spine dislocation. Orthop Traumatol Surg Res. 2010;96(4):476–9. 8. Phadnis AS, Tan CJ, Raman AS, et al. Fracture and complete dislocation of the spine with a normal motor neurology. Injury Extra 2006;37:479-83. 9. Yadla S, Lebude B, Tender GC, Sharan AD, Harrop JS, Hilibrand AS, Vaccaro AR, Ratliff JK (2008) Traumatic spondyloptosis of the thoracolumbar spine. J Neurosurg Spine 9(2):145–151 10. Zhao, C., Zhang, B., Shi, J., Li, Y., & Pang, L. (2017). Spontaneous Reduction of Fractured Thoracolumbar Spine With Complete Dislocation. Orthopaedic Nursing, 36(5), 350-355.

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