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C3-C4 spondyloptosis without neurological deficit-a case report.
Spine J 2010; 10(7):e16-20SJ

Abstract

BACKGROUND CONTEXT

Traumatic spondyloptosis of the cervical spine is usually associated with a complete, or rarely a partial, neurological deficit. Traumatic spondyloptosis with bipedicular fracture of the C3 vertebra is uncommon. To the best of the authors' knowledge, there is no report in the literature of bipedicular fracture of C3 with spondyloptosis of C3 over C4 with no neurological deficit. Literature is not clear about the role of preoperative traction in neurologically intact patients, and most authors advise both anterior and posterior fixation for cervical spondyloptosis.

PURPOSE

To report a case of C3-C4 spondyloptosis with C1 and C2 posterior arch fractures with no neurological deficit and its management strategy and underline the fact that closed reduction and limited anterior fusion can preserve the motion segment of cervical spine at other fractured levels and give a stable cervical column with good long-term results.

STUDY DESIGN

A case report with review of the literature.

METHODS

A 35-year-old man fell from a height with hyperextension-compression injury to the cervical spine. The patient suffered fracture of the posterior elements of C1-C3 along with spondyloptosis of C3 over C4 without any neurological deficit. The patient was treated with an awake nasotracheal intubation with gradual cervical traction under fluoroscopic guidance to acceptable alignment followed by anterior cervical fusion at C3-C4.

RESULTS

At 24 months' follow-up, the C3-C4 level fused completely with fracture healing at C1 and C2. The patient remained asymptomatic with normal neurological examination and near complete cervical motion. The patient returned to his preinjury job and recreational activities.

CONCLUSIONS

A case of C3-C4 spondyloptosis with associated C1-C2 posterior arch fracture is reported. The patient can present without neurological deficit if associated with a fracture of the posterior elements. Spondyloptosis without neurological deficit can be treated with gradual reduction under fluoroscopic guidance. A limited anterior-only fusion at the spondyloptosis level can provide good long-term results with preservation of other motion segments.

Authors+Show Affiliations

Department of Orthopedics, King Edward VII Memorial Hospital & Seth GS Medical College, Parel, Mumbai, Maharashtra 400012, India. kemhsks@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

20620981

Citation

Srivastava, Sudhir K., et al. "C3-C4 Spondyloptosis Without Neurological Deficit-a Case Report." The Spine Journal : Official Journal of the North American Spine Society, vol. 10, no. 7, 2010, pp. e16-20.
Srivastava SK, Agrawal KM, Sharma AK, et al. C3-C4 spondyloptosis without neurological deficit-a case report. Spine J. 2010;10(7):e16-20.
Srivastava, S. K., Agrawal, K. M., Sharma, A. K., Agrawal, M. D., Bhosale, S. K., & Renganathan, S. R. (2010). C3-C4 spondyloptosis without neurological deficit-a case report. The Spine Journal : Official Journal of the North American Spine Society, 10(7), pp. e16-20. doi:10.1016/j.spinee.2010.05.002.
Srivastava SK, et al. C3-C4 Spondyloptosis Without Neurological Deficit-a Case Report. Spine J. 2010;10(7):e16-20. PubMed PMID: 20620981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - C3-C4 spondyloptosis without neurological deficit-a case report. AU - Srivastava,Sudhir K, AU - Agrawal,Kshitij M, AU - Sharma,Amit K, AU - Agrawal,Mukta D, AU - Bhosale,Sunil K, AU - Renganathan,Sankar Ram, PY - 2009/11/18/received PY - 2010/04/17/revised PY - 2010/05/02/accepted PY - 2010/7/13/entrez PY - 2010/7/14/pubmed PY - 2010/10/22/medline SP - e16 EP - 20 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 10 IS - 7 N2 - BACKGROUND CONTEXT: Traumatic spondyloptosis of the cervical spine is usually associated with a complete, or rarely a partial, neurological deficit. Traumatic spondyloptosis with bipedicular fracture of the C3 vertebra is uncommon. To the best of the authors' knowledge, there is no report in the literature of bipedicular fracture of C3 with spondyloptosis of C3 over C4 with no neurological deficit. Literature is not clear about the role of preoperative traction in neurologically intact patients, and most authors advise both anterior and posterior fixation for cervical spondyloptosis. PURPOSE: To report a case of C3-C4 spondyloptosis with C1 and C2 posterior arch fractures with no neurological deficit and its management strategy and underline the fact that closed reduction and limited anterior fusion can preserve the motion segment of cervical spine at other fractured levels and give a stable cervical column with good long-term results. STUDY DESIGN: A case report with review of the literature. METHODS: A 35-year-old man fell from a height with hyperextension-compression injury to the cervical spine. The patient suffered fracture of the posterior elements of C1-C3 along with spondyloptosis of C3 over C4 without any neurological deficit. The patient was treated with an awake nasotracheal intubation with gradual cervical traction under fluoroscopic guidance to acceptable alignment followed by anterior cervical fusion at C3-C4. RESULTS: At 24 months' follow-up, the C3-C4 level fused completely with fracture healing at C1 and C2. The patient remained asymptomatic with normal neurological examination and near complete cervical motion. The patient returned to his preinjury job and recreational activities. CONCLUSIONS: A case of C3-C4 spondyloptosis with associated C1-C2 posterior arch fracture is reported. The patient can present without neurological deficit if associated with a fracture of the posterior elements. Spondyloptosis without neurological deficit can be treated with gradual reduction under fluoroscopic guidance. A limited anterior-only fusion at the spondyloptosis level can provide good long-term results with preservation of other motion segments. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/20620981/C3_C4_spondyloptosis_without_neurological_deficit_a_case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(10)00363-3 DB - PRIME DP - Unbound Medicine ER -