Acute Traumatic Spondyloptosis: A Case Report

Abstract

Acute traumatic spondyloptosis (ATS) is a rare condition in the orthopedic literature, with few cases reported. We present a case of ATS in a 35-year-old Hispanic male with multilevel injury, without neurological deficits at the time of injury. The patient was treated in a two-stage method consisting of combined anterior and posterior spinal decompression and fusion. At the six-month follow-up, the patient had no motor/sensory deficits, he remained stable during the one-year period. Conclusion: ATS is rarely seen in patients without neurological deficits on presentation. Although surgical intervention presents significant risks of iatrogenic neurologic compromise, surgical fixation is warranted.

Keywords: acute; asia e; fusion; lumbosacral dissociation; spine; spondylolisthesis; spondyloptosis; surgical intervention; trauma; traumatic.

Figure 1. Anterior-posterior X-ray of the lumbar spine; initial injury X-ray in the emergency room.

Figure 2. Lateral X-ray of the lumbar spine; initial injury X-ray demonstrating greater than 100% anterolisthesis L5-S1 with bilateral pedicle fractures L2-5.

Figure 3. CT lumbar spine sagittal sequence at initial presentation demonstrating bilateral pedicle fractures of L2-5 and spondyloptosis of L5-S1, causing “en bloc” lumbosacral dissociation.

Figure 4. T2 MRI lumbar spine sagittal sequence demonstrated disruption of the anterior and posterior longitudinal ligaments, complete disruption of the L5-S1 intervertebral disc, and mass effect on the lumbosacral nerve roots (cauda equina).

Figure 5. One-year follow-up anterior-posterior X-ray lumbar spine demonstrating evidence of fusion, good coronal alignment, and well-fixed orthopedic hardware.

Figure 6. One-year follow-up lateral X-ray lumbar spine demonstrating evidence of fusion, good sagittal alignment, and well-fixed orthopedic hardware.

Figure 7. One-year follow-up AP X-ray of the thoracic spine demonstrating proximal extent of orthopedic hardware with evidence of fusion and good coronal alignment.

Figure 8. One-year follow-up lateral X-ray thoracic spine demonstrating proximal extent of orthopedic hardware with evidence of fusion and good sagittal alignment.