Cervical Spondyloptosis

Dhaval Shukla

Department of Neurosurgery

NIMHANS, Bangalore.

Introduction

• Traumatic spondyloptosis of cervical spine is rare

• Allen’s classification • Compressive Extension Stage 5 (CES5)• Distractive Flexion Stage 4 (DFS4)

• Retrospective study of cervical spondyloptosis• 7 cases (1 female)• Age: 24 to 64 years

• Neurological status• No deficits 1 case• Incomplete spinal cord injury 6 cases

CT Scan

Level

C6-7 in 4 cases C7-D1 in 3 cases

Posterior Elements

Facet locking in 2 cases Fracture in 5 cases

MRI

Disc Prolapse with Normal Cord in 2

Cord Signal Changes in 4

Cord Contusion in 1

TreatmentTraction

All Cases

Complete Reduction

3 CasesAnterior Cervical

Discectomy and Fusion

with Plates and Screws

3 Cases

Partial Reduction

3 CasesAnterior Cervical

Discectomy– Facet Drilling and Lateral

Mass Fixation – Anterior

Fixation with Plates and

Screws

3 Cases

No Reduction

1 CaseFacet Drilling -

Anterior Cervical

Discectomy and Fusion

with Plates and Screws –

Lateral Mass Fixation

1 Case

Case IllustrationOnly Anterior Approach

50 / F ASIA Grade C MRI – Normal Spinal CordPreoperative Complete Reduction on TractionSurgery:1. Anterior cervical discectomy fusion with iliac crest graft

and fixation with cervical plate and screws Postop Shoulder Abduction Weakness - Improved Follow-up 10 months• ASIA Grade E • Nurick Grade 1• Good Bone Fusion

Case Illustration540◦Approach

24/ M ASIA Grade D MRI - Signal change Partial reduction on tractionSurgery:1. Anterior cervical discectomy 2. Bilateral C6-7 facetectomy, C6 laminectomy bilateral C5 lateral mass and C7 pedicle screws and rod fixation3. Anterior cervical fusion with iliac crest graft and fixation with cervical plates and screws Follow-up 6 months• ASIA Grade E• Nurick Grade 1• Good Bone Fusion