- Department of Neurosurgery, 7tir Hospital, Iran University of Medical Sciences, Tehran, Iran
Department of Neurosurgery, 7tir Hospital, Iran University of Medical Sciences, Tehran, Iran
DOI:10.4103/sni.sni_204_18Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Arash Fattahi, Abdoulhadi Daneshi. Traumatic thoracic spine spondyloptosis treated with spondylectomy and fusion. 10-Aug-2018;9:158
How to cite this URL: Arash Fattahi, Abdoulhadi Daneshi. Traumatic thoracic spine spondyloptosis treated with spondylectomy and fusion. 10-Aug-2018;9:158. Available from: http://surgicalneurologyint.com/surgicalint-articles/traumatic-thoracic-spine-spondyloptosis-treated-with-spondylectomy-and-fusion/
Background:There are multiple surgical treatment options for traumatic thoracic spine spondyloptosis, a three-column spinal injury typically attributed to high-energy trauma.
Case Description:A 20-year-old male presented with back deformity attributed to a fall. On neurological examination, he had complete spinal cord injury below the T6 level. Magnetic resonance and computed tomography imaging documented a T8 vertebral fracture and complete T7/T8 spondyloptosis. Six days following admission, he underwent a single posterior procedure consisting of a T8 spondylectomy and instrumented fusion from T5 to T11. The patient was mobilized in a wheelchair on the 3rd postoperative day and was discharged on the 11th day following admission. Three months later, the surgical construct was fused and the patient's neurological status remained unchanged.
Conclusion:Here we present a patient who following a fall sustained a T7/T8 spondyloptosis resulting in paraplegia treated with a single posterior T8 spondylectomy with T5–T11 instrumented fusion.
Keywords: Complete cord injury, spondylectomy, spondyloptosis, thoracic spine, trauma
Traumatic thoracic spine spondyloptosis (TTS) is a three-column spinal injury that typically results in paralysis.[
A 20-year-old male was admitted with paraplegia after a 9-m fall. He initially underwent emergent bilateral chest tube placement for a hemothorax. As he was paraplegic with a T6 sensory level, computed tomography thoracic studies were performed. These revealed a T8 body fracture and T7/T8 spondyloptosis [Figures
Intraoperative illustrations before (a) and after (b) spondylectomy showing complete release of the spine after T8 removal and also cross section of the cord and dura (*). Also we can see intraoperative illustration showing spinal curve after instrumentation (c). Postoperative sagittal reconstructed (d) computed tomography revealing good realignment of the spine with instrumented fusion between T5, T6, T7, T9, T10, and T11
Surgical treatment of TTS is very complex problem and requires a multidisciplinary approach. Injury to great arteries of thoracic cage and other vital organs can complicate management. With complete cord disruption, as in the case presented, delayed surgery helps reduce perioperative surgical complications and life-threatening events (e.g., aortic or vena cava injuries).
Rahimizadeh and Rahimizadeh reported a patient with a retro-spondyloptosis of T2 requiring total spondylectomy, intraoperative distraction, and T1–T3 fusion.[
Goals of surgery for TTS in patients with complete spinal cord injuries include minimizing major displacement during the reduction of displaced vertebrae to avoid great thoracic vessel injuries. Although some authors report success using axilla-pelvic distraction for deformity reduction, these procedures increase risks/complications.[
Here we presented a patient with a TTS attributed to T7/T8 spondyloptosis and a complete spinal cord injury requiring T8 spondylectomy and T5–T11 pedicle screw instrumented fusion.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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