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

Abolfazl Rahimizadeh Department of Neurosurgery, Pars Advanced & Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran; and

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Ava Rahimizadeh University of Birmingham, United Kingdom

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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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  • 1

    Ahmed A, , Mahesh BH, , Shamshery PK, & Jayaswal A: Traumatic retrolisthesis of the L4 vertebra. J Trauma 58:393394, 2005

  • 2

    Alobaid A, , Arlet V, , Ouellet J, & Reindl R: Surgical technique. Technical notes on reduction of thoracic spine fracture dislocation. Can J Surg 49:131134, 2006

  • 3

    Barberá J: T12-L1 telescoped chronic dislocation treated by en bloc one-piece spondylectomy and spine shortening. J Spinal Disord Tech 17:163166, 2004

  • 4

    Bellew MP, & Bartholomew BJ: Dramatic neurological recovery with delayed correction of traumatic lumbar spondyloptosis. Case report and review of the literature. J Neurosurg Spine 6:606610, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Bohlman HH: Treatment of fractures and dislocations of the thoracic and lumbar spine. J Bone Joint Surg Am 67:165169, 1985

  • 6

    Bohlman HH, , Freehafer A, & Dejak J: The results of treatment of acute injuries of the upper thoracic spine with paralysis. J Bone Joint Surg Am 67:360369, 1985

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Denis F, & Burkus JK: Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine (Phila Pa 1976) 17:156161, 1992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    el-Khoury GY, & Whitten CG: Trauma to the upper thoracic spine: anatomy, biomechanics, and unique imaging features. AJR Am J Roentgenol 160:95102, 1993

  • 9

    El Masri WS, & Silver JR: Traumatic spondyloptosis of the dorsal spine with incomplete neurological deficit. Injury 15:3537, 1983

  • 10

    Gitelman A, , Most MJ, & Stephen M: Traumatic thoracic spondyloptosis without neurologic deficit, and treatment with in situ fusion. Am J Orthop 38:E162E165, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Hutchinson MR, & Dall BE: Fracture-dislocation of the thoracic and lumbar spine: advantages of halo-bifemoral traction. J Spinal Disord 6:482488, 1993

  • 12

    Korovessis P, , Sidiropoulos P, & Dimas A: Complete fracture-dislocation of the thoracic spine without neurologic deficit: case report. J Trauma 36:122124, 1994

  • 13

    Lee CW, , Hwang SC, , Im SB, , Kim BT, & Shin WH: Traumatic thoracic spondyloptosis: a case report. J Korean Neurosurg Soc 35:622624, 2004

  • 14

    London PS: Fracture-dislocations of the spine that may spare the cord: an explanation. Injury 24:347349, 1993

  • 15

    Sapkas GS, , Papagelopoulos PJ, , Papadakis SA, , Themistocleous GS, , Stathakopoulos DP, & Efstathiou P, et al.: Thoracic spinal injuries: operative treatments and neurologic outcomes. Am J Orthop (Belle Mead NJ) 32:8588, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Sekhon LH, , Sears W, & Lynch JJ: Surgical management of traumatic thoracic spondyloptosis: review of 2 cases. J Clin Neurosci 14:770775, 2007

  • 17

    Shapiro S, , Abel T, & Rodgers RB: Traumatic thoracic spinal fracture dislocation with minimal or no cord injury. Report of four cases and review of the literature. J Neurosurg 96:3 Suppl 333337, 2002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Simpson AH, , Williamson DM, , Golding SJ, & Houghton GR: Thoracic spine translocation without cord injury. J Bone Joint Surg Br 72:8083, 1990

  • 19

    Wang F, & Zhu Y: Treatment of complete fracture-dislocation of thoracolumbar spine. J Spinal Disord Tech 26:421426, 2013

  • 20

    Wilkinson JS, , Riesberry MA, , Mann SA, & Fourney DR: Traumatic lateral expulsion of the L-4 vertebral body from the spinal column. J Neurosurg Spine 14:508512, 2011

  • 21

    Yadla S, , Lebude B, , Tender GC, , Sharan AD, , Harrop JS, & Hilibrand AS, et al.: Traumatic spondyloptosis of the thoracolumbar spine. J Neurosurg Spine 9:145151, 2008

  • 22

    Zhou TH, , Tang X, , Xu YQ, & Zhu YL: Traumatic spondyloptosis of L4. Spine (Phila Pa 1976) 35:E855E859, 2010

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