gms | German Medical Science

Objective: Traumatic spondyloptosis is the subluxation of one vertebral body on another in coronal or sagittal plane more than%100. This rare condition mostly appears at the lumbosacral junction and can be caused by trauma, infection, degeneration, tumor or congenital defects.

Method: Sixteen year-old male patient crushed by a forklift at work, was taken to the emergency room with confusion, paraplegia and hemodynamic instability. Radiologic study has shown diaphragmatic hernia in left side, laceration of spleen, contusion areas at liver parenchyma, areas that are compatible with infarction at left kidney, minimal pneumothorax at right lung, atelectatic ares at both lungs, grade V antherolisthesis at L1-L2 and visions of fragmented bones neighbouring vertebra corpuses, fracture lines in spinous and transverse processes of L1, L2, L3. After reparation of diaphragmatic injury, splenectomy operation and insertion of chest tube to both sides by pediatric surgery, the patient was followed at the intensive care unit for 10 days. After being hemodynamically stable, he was taken over by our neurosurgery clinic and operated in order to apply posterior segmental instrumentation. Open reduction and transpedicular screw was used for stabilization and fusion.

Results: Full neurologic damage (Frankel A) was occured due to traumatic spondyloptosis and total spinal cord transection caused by flexion dislocation injury accompanied with facet fracture. These kinds of traumas usually come along with injuries to other organs. Patient was taken over by our neurosurgery clinic and operated after he had hemodynamically stabilized as possible as he can. During surgical planning plain radiography, computerized tomography (CT), magnetic resonance imaging (MRI) were used in order to get detailed information and determine the fracture’s location, intension, type, shift plane, angle and condition of ligamentous support units. Surgical technique depends on the patient’s general condition, age and degree of spinal cord injury.

Conclusions: Thus, multidisciplinary approach is essential for these patients and they must receive pre-operative and post-operative intense psychiatric support and physical therapy and rehabilitation till discharge. They should be directed to neurorehabilitation centres afterwards.