Traumatic thoracolumbar spondyloptosis of T12-L1 with stable hemodynamics: A case report

Abstract

Introduction and importance: A fracture-dislocation of the vertebral bone is mostly caused by high-energy trauma. Spondyloptosis is the severest form of spondylolisthesis (>100 %) which affects the sagital or coronal plane from the contiguous vertebral bone. Anterior spondyloptosis is known as fracture-dislocation where the proximal part of the vertebra is located infront of the distal vertebrae. Most cases are associated with spinal cord injury (SCI) and unstable hemodynamics, in this case the vital sign of the patient's tend to be stable.

Case presentation: A 21-year-old man had multiple traumas after having a traffic injury, pain and numbness were positive during physical examination, especially in both lower limb. A radiography examination shows that the patient had total spinal cord transection and anterior spondyloptosis in T12 until L1 segment. Additional examinations found minimal renal and liver contusion including the ischemic bowel. The interbody fusion procedure was chosen as our therapeutic modalities.

Clinical discussion: We performed open surgical methods by using interbody fusion modalities usually in patient's with stable vital signs. This intervention could be the priority in managing patients with a rare case of anterior spondyloptosis. A visual analog Scale (VAS) was used for monitoring the degree of pain, and Oswestry Disability Index (ODI) questionnaire for evaluating the outcome for low back pain.

Conclusions: Most traumatic spondyloptosis cases end with neurogenic shock, Due to the injury's rarity and collaborated with minimal soft tissue injury, early diagnosis and the use of an open surgical method may improve patient's outcome.

Keywords: Case report; Hemodynamics; Spinal cord injury; Spondyloptosis.

Fig. 1

CT scan demonstrating the T12-L1 with AP-View (A) anterior spondyloptosis on initial condition found in sagittal view (B) Lumbar x-ray AP-View shows soft tissue swelling on upper right quadrant (C) Sagital view of X-ray examination shows anterior shift (D).

Fig. 2

Intra-operative demonstrating the T12-L1 by using laminectomy procedure with posterior approach.

Fig. 3

Lateral X-ray view taken intra-operatif showing T10-L2 interbody fusion procedure.

Fig. 4

Anteroposterior X-ray view underlying fusion procedure.