Limits...
Traumatic spondyloptosis of the lumbar spine: a case report.

Amesiya R, Orwotho N, Nyati M, Mugarura R, Mwaka ES - J Med Case Rep (2014)

Bottom Line: It results in complete disruption of the structural elements of the vertebral column and the adjacent paravertebral soft tissues, culminating in severe biomechanical instability.He is currently undergoing rehabilitation and is steadily improving, 2 months postoperatively.In limited-resource settings there is a tendency of "skilful neglect" of complex injuries.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedics department, School of Medicine, Makerere University, P,O, Box 7072, Kampala, Uganda. erisamwaka@yahoo.com.

ABSTRACT

Introduction: Spondyloptosis is the most severe of translation spine injuries. It results in complete disruption of the structural elements of the vertebral column and the adjacent paravertebral soft tissues, culminating in severe biomechanical instability. Although several cases of lumbosacral spondyloptosis have been documented, not many cases of traumatic lumbar spondyloptosis have been published in the literature.

Case presentation: We present a case of a 34-year-old man of Nilo-Hamitic ethnicity who presented to our unit with paraplegia following injury from the collapse of a concrete wall. Radiographic images showed spondyloptosis at the fourth lumbar vertebral level. He underwent surgery where decompression, reduction, posterior instrumentation and bone grafting through a posterior approach were done. He started regaining motor power 48 hours postoperatively. He is currently undergoing rehabilitation and is steadily improving, 2 months postoperatively.

Conclusions: In limited-resource settings there is a tendency of "skilful neglect" of complex injuries. Where resources allow, surgical reconstruction of spondyloptosis should be attempted irrespective of the severity of the initial neurological deficit because there are chances of neurological improvement.

Show MeSH

Related in: MedlinePlus

Preoperative radiographs. Plain anteroposterior (a) and lateral radiographs (b) of the lumbar spine showing spondyloptosis with L4 lying anterior to the L5 vertebral body in the sagittal plane.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4307633&req=5

Fig1: Preoperative radiographs. Plain anteroposterior (a) and lateral radiographs (b) of the lumbar spine showing spondyloptosis with L4 lying anterior to the L5 vertebral body in the sagittal plane.

Mentions: A 38-year-old man of Nilo-Hamitic ethnicity was admitted to our spine unit with paraplegia following an injury to his lumbar spine. He was hit in the back while trying to escape from a collapsing concrete wall. He presented with severe lower back pain, inability to move his lower limbs, urine retention and altered sensation in his legs and feet. He was fully conscious, and had an obvious hyperlordotic deformity and bruising in his lumbar region. He had muscle power grade 0/5 and cutaneous sensory loss below the L3 level bilaterally. He had no perianal sensation and rectal tone was absent. We graded him as ASIA A. Plain radiographs (FigureĀ 1) showed sagittal misalignment of his lumbar spine with complete anterior translation of L4 on L5. There also was a left transverse process fracture of L4. We had no access to computed tomography scans and magnetic resonance imaging.Figure 1


Traumatic spondyloptosis of the lumbar spine: a case report.

Amesiya R, Orwotho N, Nyati M, Mugarura R, Mwaka ES - J Med Case Rep (2014)

Preoperative radiographs. Plain anteroposterior (a) and lateral radiographs (b) of the lumbar spine showing spondyloptosis with L4 lying anterior to the L5 vertebral body in the sagittal plane.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307633&req=5

Fig1: Preoperative radiographs. Plain anteroposterior (a) and lateral radiographs (b) of the lumbar spine showing spondyloptosis with L4 lying anterior to the L5 vertebral body in the sagittal plane.
Mentions: A 38-year-old man of Nilo-Hamitic ethnicity was admitted to our spine unit with paraplegia following an injury to his lumbar spine. He was hit in the back while trying to escape from a collapsing concrete wall. He presented with severe lower back pain, inability to move his lower limbs, urine retention and altered sensation in his legs and feet. He was fully conscious, and had an obvious hyperlordotic deformity and bruising in his lumbar region. He had muscle power grade 0/5 and cutaneous sensory loss below the L3 level bilaterally. He had no perianal sensation and rectal tone was absent. We graded him as ASIA A. Plain radiographs (FigureĀ 1) showed sagittal misalignment of his lumbar spine with complete anterior translation of L4 on L5. There also was a left transverse process fracture of L4. We had no access to computed tomography scans and magnetic resonance imaging.Figure 1

Bottom Line: It results in complete disruption of the structural elements of the vertebral column and the adjacent paravertebral soft tissues, culminating in severe biomechanical instability.He is currently undergoing rehabilitation and is steadily improving, 2 months postoperatively.In limited-resource settings there is a tendency of "skilful neglect" of complex injuries.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedics department, School of Medicine, Makerere University, P,O, Box 7072, Kampala, Uganda. erisamwaka@yahoo.com.

ABSTRACT

Introduction: Spondyloptosis is the most severe of translation spine injuries. It results in complete disruption of the structural elements of the vertebral column and the adjacent paravertebral soft tissues, culminating in severe biomechanical instability. Although several cases of lumbosacral spondyloptosis have been documented, not many cases of traumatic lumbar spondyloptosis have been published in the literature.

Case presentation: We present a case of a 34-year-old man of Nilo-Hamitic ethnicity who presented to our unit with paraplegia following injury from the collapse of a concrete wall. Radiographic images showed spondyloptosis at the fourth lumbar vertebral level. He underwent surgery where decompression, reduction, posterior instrumentation and bone grafting through a posterior approach were done. He started regaining motor power 48 hours postoperatively. He is currently undergoing rehabilitation and is steadily improving, 2 months postoperatively.

Conclusions: In limited-resource settings there is a tendency of "skilful neglect" of complex injuries. Where resources allow, surgical reconstruction of spondyloptosis should be attempted irrespective of the severity of the initial neurological deficit because there are chances of neurological improvement.

Show MeSH
Related in: MedlinePlus