Management of traumatic cervical spondyloptosis in a neurologically intact patient: case report.Spine (Phila Pa 1976) 2009; 34(19):E703-8S
To review the management of a neurologically intact patient with complete cervical spondyloptosis with particular attention to the role and timing of closed preoperative cervical traction and subsequent stabilization.
SUMMARY OF BACKGROUND DATA
Traumatic cervical spondyloptosis is typically associated with complete and irreversible spinal cord injury. In these patients, cervical traction can be implemented to restore anatomic alignment in preparation for stabilization with minimal consequence. When a patient presents neurologically intact, the management becomes more complicated. Preservation of function and restoration of anatomic alignment collectively represent the goals of therapy. The current literature does not clearly define the role of cervical traction in such cases.
A patient with traumatic cervical spondyloptosis at the C7-T1 level presented to our institution and was found to be neurologically intact. Computed tomography demonstrated complete spondyloptosis with multiple fractures through the posterior elements.
The spondyloptosis was reduced with closed cervical traction and underwent anterior and posterior instrumented stabilization. No new deficit occurred in the patient after reduction.
Fractures of the posterior elements functionally decompress the spinal canal and thereby allow for cervical traction to be safely implemented in patients with spondyloptosis. Safe restoration of anatomic alignment in the neurologically intact spondyloptotic patient is crucial to minimize the extent of surgical stabilization and create a long-term stable construct of the fracture dislocation.