Posttraumatic C2-C3 spondyloptosis without focal neurological deficit, treated with anterior and posterior approaches: A case report.

BACKGROUND: Cervical spondyloptosis is usually caused by trauma, and correlated with significant neurological deficits that can include quadriplegia, respiratory disorders, vertebral artery injury, and death. CASE DESCRIPTION: A 34-year-old male presented with C2-C3 spondylolisthesis after a fall from a tree. Although he had no neurological deficits, CT and X-ray studies confirmed C2-C3 a spondyloptosis. He was treated with emergent anterior and posterior cervical reduction, decompression, and fixation, remaining neurologically intact in the postoperative period.
CONCLUSION: Patients with C2-C3 spondyloptosis documented on X-ray/CT studies should be considered for circumferential decompression/fusion to preserve neurological function. Copyright:

INTRODUCTION

Cervical spondyloptosis is the most severe type of spondylolisthesis and is[1] usually attributed to trauma.[3] It usually results in a significant neurological deficit often characterized by; quadriplegia, respiratory disorders, vertebral artery injury, and even death.[3]

CASE STUDY

A 34-year-old male fell from a tree 3 m high. When transferred, he was neurologically intact. The cervical CT scan demonstrated traumatic C2-C3 spondylolisthesis with bilateral C2 pars interarticularis fractures (i.e. A hangman’s fracture). The patient underwent Gardner-Wells traction (i.e. 7.5 kg). However, when this failed to provide realignment, he first underwent an anterior fusion Consisting of C2-C3 discectomy, partial C2 and C3 corpectomy with cage/plate placement [Figure 1].

Figure 1:

Radiologic view of cervical spine before surgery: first day Cervical MRI (STIR view) (a), 1st day Cervical MRI (T2 view) (b), 1st day cervical CT (c), and CT scan on the 14th day (d).

Three weeks later, due to increased anterior displacement, a secondary posterior fusion was performed warranting. C1-C3 fusion with bilateral C1 hooks, C2 trans-pars screws, and C3 lateral mass screws and rods. Four months later, the patient went on to fuse without any neurological deficit [Figure 2].

Figure 2:

Radiologic view of cervical spine after surgery: after anterior approach cervical XR, (a) cervical XR on the 3rd week after anterior approach (b), and cervical XR after posterior approach (c).

DISCUSSION

We identified four other cases of spondyloptosis at the C2-C3 level. These were attributed to; new trauma (1 case), old trauma (1 case), absence of all C2 vertebral posterior elements, (1 case), and a motor vehicle accident (1 case) [Table 1].[2-5] Traumatic cervical fractures should be observed carefully, with great attention to “red flag symptoms” (i.e. the onset of neurological deficits, and further subluxation) Many of these patients warrant early consideration of decompression/fusion [Table 1].

Table 1:

Cases reported with C2-C3 spondyloptosis.

Although Gardner-Wells traction should be acutely utilized to prevent further subluxation and increased neurological injury, circumferential surgical decompression/stabilization is the “gold standard.”