Traumatic Spondyloptosis of the Thoracolumbar SpineThe authors described five case studies of patients who suffered traumatic spondyloptosis of the thoracolumbar junction. This is a rare but severe injury. There is complete fracture dislocation of the spine. These injuries have the highest association with spinal cord injury of all fracture types. The thoracolumbar junction is involved in 15 percent of all spinal cord injuries. Three of the five patients were involved in high speed motor vehicle crashes. One sustained the injury when a building collapsed. The other was struck by a steel beam.
Four of the subjects had 100 percent subluxation in the sagittal plane. One had 100 percent subluxation in the coronal plane. The four subjects with sagittal plane disruption of their spinal column had complete spinal cord injury at the time of presentation. The patient with coronal plane disruption had incomplete spinal cord injury at the time of presentation.
Early stabilization of the spine allows early mobilization or activity. In the case of incomplete neurological injury, decompression and stabilization of the spine is hoped to improve neurological recovery as soon as possible The surgical procedure must allow for distraction of impacted vertebral bodies, restoration of alignment, and maintenance of alignment with stable internal fixation. All subjects underwent surgery to stabilize the spinal column in hopes of improving or restoring neurological function. Two subjects had single stage posterior fusion with pedicle screw and rod instrumentation. Three patients underwent staged posterior, then anterior fusion.
One patient could not be reached for follow up. Three who had complete spinal cord injuries had no improvement in neurological function. The patient with incomplete injury had improvement in lower extremity strength and was independently ambulating at six months following surgery. Other case reports have demonstrated similar findings and results with coronal plane spondyloptosis. The authors conclude that coronal plane spondyloptosis can be associated with incomplete spinal cord injury with the potential for favorable recovery of function.
S. Yadla, et al. Traumatic spondyloptosis of the thoracolumbar spine.J Neurosurg Spine August 2008. Volume 9, Number 2. Pp. 145-151.
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