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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.

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Related in: MedlinePlus

Postoperative antero-posterior (a) and lateral (b) radiographs of the lumbar spine. Good reduction is shown with short segment posterolateral fixation.
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Fig2: Postoperative antero-posterior (a) and lateral (b) radiographs of the lumbar spine. Good reduction is shown with short segment posterolateral fixation.

Mentions: The patient was stabilized and had spine surgery 4 days after injury. He had no chronic diseases and this was his index surgery. He was positioned prone on a spine frame and his spine approached through a longitudinal midline incision, exposing L3-S1 vertebrae. We found: extensive contusion and disruption of his musculoligamentous structures; an obvious dislocation at the L4/5 level with disruption of the zygapophyseal joints; fractures of the pars, tip of the spinous process and left transverse process of the L4 vertebra; and cerebrospinal fluid leakage. Decompression of the neural elements was done first, through an L4 laminectomy. The thecal sac was found to have ruptured, but with no obvious injury to the cauda equina. Good reduction of the dislocation (FigureĀ 2) was achieved through a process of distraction and leverage of the L4 vertebra using a laminar spreader and periosteal elevators. Posterolateral spinal fusion was then done using pedicle screw instrumentation. Pedicle screws were placed bilaterally into the L4 and L5 vertebral bodies using a free hand technique. Then, pre-bent titanium rods were placed in the screw heads and the screw caps tightened. A bone graft was then harvested from the right posterior iliac crest; and together with morselized bone obtained from the surgical site, the graft was packed into the lateral gutters. The dura was carefully repaired and wound closure done in the standard manner. There was no intraoperative fluoroscopic guidance or neurophysiological monitoring during the entire procedure.Figure 2


Traumatic spondyloptosis of the lumbar spine: a case report.

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

Postoperative antero-posterior (a) and lateral (b) radiographs of the lumbar spine. Good reduction is shown with short segment posterolateral fixation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Postoperative antero-posterior (a) and lateral (b) radiographs of the lumbar spine. Good reduction is shown with short segment posterolateral fixation.
Mentions: The patient was stabilized and had spine surgery 4 days after injury. He had no chronic diseases and this was his index surgery. He was positioned prone on a spine frame and his spine approached through a longitudinal midline incision, exposing L3-S1 vertebrae. We found: extensive contusion and disruption of his musculoligamentous structures; an obvious dislocation at the L4/5 level with disruption of the zygapophyseal joints; fractures of the pars, tip of the spinous process and left transverse process of the L4 vertebra; and cerebrospinal fluid leakage. Decompression of the neural elements was done first, through an L4 laminectomy. The thecal sac was found to have ruptured, but with no obvious injury to the cauda equina. Good reduction of the dislocation (FigureĀ 2) was achieved through a process of distraction and leverage of the L4 vertebra using a laminar spreader and periosteal elevators. Posterolateral spinal fusion was then done using pedicle screw instrumentation. Pedicle screws were placed bilaterally into the L4 and L5 vertebral bodies using a free hand technique. Then, pre-bent titanium rods were placed in the screw heads and the screw caps tightened. A bone graft was then harvested from the right posterior iliac crest; and together with morselized bone obtained from the surgical site, the graft was packed into the lateral gutters. The dura was carefully repaired and wound closure done in the standard manner. There was no intraoperative fluoroscopic guidance or neurophysiological monitoring during the entire procedure.Figure 2

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