Traumatic lumbar spondylolisthesis resulting in complete thoracic spinal cord avulsion: an unusual presentation

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Traumatic spondylolisthesis is a known occurrence in trauma, but complete cord transection is relatively rare. Moreover, complete cord transection at a site distant from the traumatic spondylolisthesis without spondyloptosis is exceedingly rare. In this report, authors describe the first case of thoracic cord avulsion following a traumatic grade II lumbar spondylolisthesis. The unusual presentation of this case highlights the importance of further evaluating patients with neurological symptoms out of proportion with the injuries seen on initial imaging. Magnetic resonance imaging performed after initial imaging studies demonstrated T11 cord transection with the distal cord herniating into the lumbar paraspinal soft tissues, thus allowing for preoperative planning to prepare for a more significant intervention including complex dural repair and lumbar drain placement, in addition to instrumented fusion to stabilize the traumatic spondylolisthesis.

ABBREVIATIONS MRC = Medical Research Council.

Article Information

Correspondence Rafael A. Vega: Virginia Commonwealth University Health System, Medical College of Virginia, Richmond, VA. rafael.vega@vcuhealth.org.

INCLUDE WHEN CITING Published online September 7, 2018; DOI: 10.3171/2018.5.SPINE17919.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Computed tomography scan demonstrating acute traumatic grade II lumbar spondylolisthesis of L4 on L5 with 10 mm of posterior displacement.

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    Preoperative MR image of the thoracolumbar spine revealing complete transection of the spinal cord at the level of T11 and herniation of the dura and spinal canal contents through the ligamentum flavum at the level of the lumbar disc disruption at L4–5.

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    Portion of the transected thoracic spinal cord seen in the caudal region of the dural sac in the lumbar spine with clumping of the nerve roots surrounding the field. Figure is available in color online only.

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    Postoperative imaging. Left: Radiograph with anteroposterior projection. Right: Sagittal CT demonstrating proper alignment of the spinal column after pedicle screw fixation.

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    Sagittal T2-weighted MR image of the thoracolumbar spine obtained at the 2-year follow-up, revealing atrophic regions and irregular cystic replacement of the normal thecal sac within the spinal canal. Additionally, no nerve roots are visible from T11 to L5.

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