Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries: A case report and literature review

Abstract

Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L₃ spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.

Keywords: American Spinal Injury Association; Fracture dislocation; Lumbar spine; Multiple trauma; Spondyloptosis.

Fig. 1

Three-dimensional reconstruction of CT scans in local hospital. Scapular fractures and rib fractures (A), L₃ spondyloptosis combined with proximal femoral fracture and lumbar vertebra fracture (B) were enclosed by the red ellipse.

Fig. 2

Detailed L₃ spondyloptosis and its relationship with anterior large vessels. Complete anterior spondyloptosis of L₃ was confirmed by two separate intensified or non-intensified CT planes (A and B), sagittal scan (C) and reconstruction images (D). Further CT angiography was conducted, compression of large vessels comprising both inferior vena cava and abdominal aorta were discovered from several CT axial planes (E) and reconstruction images (F).

Fig. 3

The placement of vena cava filter. To prevent thrombosis caused by vascular stenosis, a vena cava filter was imbedded into the inferior vena cava and the position was ensured (A and B).

Fig. 4

First posterior internal fixation. To stabilize the spinal alignment balance, posterior bilateral pedicle screw fixation and rods construction were performed on segment L₁, L₂, L₄, and L₅ vertebral bodies. Intraoperative fluoroscopy (A) and postoperative radiography, coronal (B) and sagittal (C), demonstrated successful restoration. Cut plane (D), coronal (E) and sagittal (F) CT scan revealed a mild retraction of L₃ vertebra.

Fig. 5

Second anterior internal fixation. We performed vertectomy of the fractured L₃ vertebrae body (A) and placed a cage between L₂ and L₄ (B). Morselized bone harvested from L₃ was packed into cage. The spinal alignment was restored as implied by postoperative radiography plain of coronal (C) and sagittal (D).

Fig. 6

Rehabilitation functions at postoperative 6-month follow-up. At postoperative 6-month, this patient was identified to have incomplete neurological improvement (A and B). Postoperative radiography plain (C) and CT scan (D) demonstrated a stable spinal alignment.