Traumatic spondyloptosis of L3 with incomplete neurological involvement: A case report

Abstract

High-energy traumas frequently result in lumbar spine fractures such as spondyloptosis is the maximum expression of instability and severity. The management of spondyloptosis is complex and, essentially, surgical. It usually presents with irreversible neurological compromise. This paper aimed to present a case of lumbar spondyloptosis and its early confrontation, partial neurological involvement, and progressive postoperative retrieval.

Clinical case: A male patient aged 42 years had multiple injuries with asymmetric paraparesis and sphincter involvement. Computed tomography (CT) revealed L3 vertebral spondyloptosis detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. Surgical resolution was defined by performing an en bloc corpectomy through lumbotomy and the installation of an expandable cage with posterior transpedicular fixation of L2-L4, thereby recovering the spinal canal diameter, lumbar lordosis, sagittal balance, and improving motor function progressively.

Conclusion: Complex spinal injuries warrant an early resolution by a trained surgical team to ensure normal spinal parameters and to achieve a progressive neurological recovery.

Keywords: Intraoperative neurophysiological monitoring; Lordosis; Lumbar vertebrae; Spinal fusion; Trauma.

Fig. 1

L3 vertebral body removed en bloc via the anterolateral approach.

Fig. 2

Left lumbotomy showing the psoas, great vessels, and expandable cage in position.

Fig. 3

Intraoperative lateral radiographic image showing the final construct.

Fig. 4

Sagittal computed tomography scan of the thoracolumbar spine. The left image shows L3 vertebral body spondyloptosis and sagittal imbalance, and the right image shows the recovery of sagittal balance.