The Spine Journal 14 (2014) 194–195
Significant neurologic recovery after traumatic cervical spondyloptosis and spinal cord injury Images of spine care The patient is a 28-year-old woman who fell from a second-floor balcony. She was noted to be paraplegic and unable to use her hands and was found to have American Spinal Injury Association Impairment Scale (AIS) Grade B spinal cord injury. Imaging included computed tomography (CT) of the cervical spine that revealed traumatic spondyloptosis of C6–C7 (Fig. 1). The patient underwent CT angiography, which revealed no evidence of vertebral artery
Fig. 1. A three-dimensional reconstruction of the computed tomography of the cervical spine revealing traumatic spondyloptosis of C6–C7. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.08.002
injury [1] and was then immediately placed in craniocervical traction [2]. Attempts at closed reduction were unsuccessful despite progressive increasing weights. The patient was then taken to the operating room for open reduction. She underwent posterior decompressive laminectomies at C6 and C7 and the jumped facet joints were drilled off until the dislocation reduced. She then underwent multilevel posterior segmental cervicothoracic instrumentation and fusion from C3 to T3 (lateral mass screws at C3, C4, and C5 and laminar screws at T2 and T3; Fig. 2). Postoperatively, the patient remained AIS Grade B. At 6-months follow-up, the patient was noted to have made significant neurologic recovery and had only some residual hand grip weakness (AIS Grade D). The patient reported that she was currently training for a half marathon.
Fig. 2. A postoperative lateral plain film radiograph revealing the cervicothoracic instrumentation from C3 to T3.
S.S. Dhall and E.A. Sribnick / The Spine Journal 14 (2014) 194–195
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A CT revealed maturing fusion mass across the injured segment and maintained alignment (Fig. 3). There are reports of patients with spondyloptosis who present neurologically intact following injury [3]; however, to our knowledge, this is one of the first reported cases of recovery from paraplegia to near normal neurologic function after traumatic cervical spondyloptosis. References [1] Harrigan MR, Hadley MN, Dhall SS, et al. Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery 2013;72:234–43. [2] Gelb DE, Hadley MN, Aarabi B, et al. Initial closed reduction of cervical spinal fracture-dislocation injuries. Neurosurgery 2013;72: 73–83. [3] Tumialan LM, Dadashev V, Laborde DV, Gupta SK. Management of traumatic cervical spondyloptosis in a neurologically intact patient: case report. Spine 2009;34:E703–8.
Sanjay S. Dhall, MD Eric A. Sribnick, MD, PhD Department of Neurological Surgery Emory University School of Medicine Atlanta GA 30322 USA
Fig. 3. A sagittal view computed tomography performed at 6 months after surgery revealing arthrodesis.
FDA device/drug status: Not applicable. Author disclosures: SSD: Nothing to disclose. EAS: Nothing to disclose.
Significant neurologic recovery after traumatic cervical spondyloptosis and spinal cord injury Images of spine care The patient is a 28-year-old woman who fell from a second-floor balcony. She was noted to be paraplegic and unable to use her hands and was found to have American Spinal Injury Association Impairment Scale (AIS) Grade B spinal cord injury. Imaging included computed tomography (CT) of the cervical spine that revealed traumatic spondyloptosis of C6–C7 (Fig. 1). The patient underwent CT angiography, which revealed no evidence of vertebral artery
Fig. 1. A three-dimensional reconstruction of the computed tomography of the cervical spine revealing traumatic spondyloptosis of C6–C7. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.08.002
injury [1] and was then immediately placed in craniocervical traction [2]. Attempts at closed reduction were unsuccessful despite progressive increasing weights. The patient was then taken to the operating room for open reduction. She underwent posterior decompressive laminectomies at C6 and C7 and the jumped facet joints were drilled off until the dislocation reduced. She then underwent multilevel posterior segmental cervicothoracic instrumentation and fusion from C3 to T3 (lateral mass screws at C3, C4, and C5 and laminar screws at T2 and T3; Fig. 2). Postoperatively, the patient remained AIS Grade B. At 6-months follow-up, the patient was noted to have made significant neurologic recovery and had only some residual hand grip weakness (AIS Grade D). The patient reported that she was currently training for a half marathon.
Fig. 2. A postoperative lateral plain film radiograph revealing the cervicothoracic instrumentation from C3 to T3.
S.S. Dhall and E.A. Sribnick / The Spine Journal 14 (2014) 194–195
195
A CT revealed maturing fusion mass across the injured segment and maintained alignment (Fig. 3). There are reports of patients with spondyloptosis who present neurologically intact following injury [3]; however, to our knowledge, this is one of the first reported cases of recovery from paraplegia to near normal neurologic function after traumatic cervical spondyloptosis. References [1] Harrigan MR, Hadley MN, Dhall SS, et al. Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery 2013;72:234–43. [2] Gelb DE, Hadley MN, Aarabi B, et al. Initial closed reduction of cervical spinal fracture-dislocation injuries. Neurosurgery 2013;72: 73–83. [3] Tumialan LM, Dadashev V, Laborde DV, Gupta SK. Management of traumatic cervical spondyloptosis in a neurologically intact patient: case report. Spine 2009;34:E703–8.
Sanjay S. Dhall, MD Eric A. Sribnick, MD, PhD Department of Neurological Surgery Emory University School of Medicine Atlanta GA 30322 USA
Fig. 3. A sagittal view computed tomography performed at 6 months after surgery revealing arthrodesis.
FDA device/drug status: Not applicable. Author disclosures: SSD: Nothing to disclose. EAS: Nothing to disclose.
