Delayed surgical treatment of asymptomatic severe traumatic C7-T1 spondylolisthesis: a rare case report from Syria

Abstract

Introduction: Spondylolisthesis is described as the displacement of one vertebra over another, leading to spinal instability and potential nerve compression. When this occurs in the cervicothoracic junction, it can result in unique clinical manifestations. High-grade spondylolisthesis caused by trauma in the cervicothoracic junction of the spine usually results in acute spinal cord injury and quadriparesis. However, a few uncommon cases of the same injury reported minimal or no neurological deficits. Biomechanical evaluation of the underlying pathology can offer insights into the mechanism of injury and the preservation of neurological function.

Case presentation: This paper explains the case of a 32-year-old white male patient who suffered from a traumatic C7-T1 spondylolisthesis. Despite having radiographic evidence of grade III traumatic spondylolisthesis, cord compression, fracture in the isthmus of the C7 vertebra, and intervertebral disc traumatic change and protrusion, the patient did not exhibit any motor neurological deficits. The patient underwent posterior spine fixation via the posterior approach as the first step of the surgical management, followed by anterior spine fixation via the anterior approach after several days (360° fixation). Fortunately, after 6 months of follow-up, the patient showed good outcomes. The patient was pain-free with an intact neurological clinical examination, the radiographs showed well-maintained fusion and alignment.

Discussion: The best management approach to cervical spondylolisthesis without neurological injury is complicated and arguable due to the rarity of occurrence of such cases.

Conclusion: A combined anteroposterior surgical approach, or 360° fixation, is a valuable technique for addressing complex spinal conditions such as the condition seen in our case, offering comprehensive stabilization and improved outcomes.

Keywords: Cervical spondylolisthesis; cervicothoracic junction; neurological deficit; spinal trauma.

Figure 1

Shows preoperative sagittal T2-weighted MRI image with complete spondylolisthesis at C7–T1 level anterograde displacement accompanied by disc protrusion. Spinal cord compression at the first thoracic level, evident by a high-signal intensity focus on the same level in the subsequent time frame, potentially indicative of contusion. Signs of both anterior and posterior longitudinal ligament injuries are observed.

Figure 2

Shows immediate postoperative sagittal T2-weighted MRI with an improvement in alignment, as well as alleviation of compression and a reduction in oedema.

Figure 3

Shows a simple anteroposterior X-ray image of the cervical spine that demonstrates screws and two rods at the C6–C7–T1 vertebral levels and an anterior plate extending from C6 to T1.

Figure 4

Shows a simple lateral X-ray image of the cervical spine that demonstrates screws and two rods at the C7–T1–T2 vertebral levels and an anterior plate extending from C6 to T1.