sponlyloptosis
Post on 01-Jun-2015
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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
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