Management and Outcomes of Adult Traumatic Cervical Spondyloptosis: A Case Report and Systematic Review

Authors

Christina Ng, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Eric Feldstein, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Eris Spirollari, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Sima Vazquez, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Alexandria Naftchi, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Gillian Graifman, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Ankita Das, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Cameron Rawanduzy, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Christian Gabriele, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Ronan Gandhi, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Sabrina Zeller, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States. Electronic address: Jose.Dominguez@wmchealth.org.
Jonathan D. Krystal, Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States.
John K. Houten, Department of Neurosurgery, Maimonides Medical Center and Hofstra-Northwell School of Medicine, Brooklyn, NY 11219, United States.
Merritt D. Kinon, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.

Author Type(s)

Faculty, Resident/Fellow

Journal Title

Journal of Clinical Neuroscience

First Page

34

Last Page

40

Document Type

Article

Publication Date

9-1-2022

Department

Neurosurgery

Abstract

STUDY DESIGN: Systematic Review. OBJECTIVE: To elucidate treatment modalities and outcomes of patients with traumatic cervical spondyloptosis (TCS). SUMMARY: Traumatic cervical spondyloptosis (TCS) is rare and typically leads to devastating neurological injury. Management strategies vary from case to case. METHODS: A systematic review of the literature identified cases of adult TCS, and data was analyzed to characterize the patient population and to assess factors that influenced clinical outcome. In addition, an illustrative case is presented in which closed reduction of a severe C7-T1 spondyloptosis injury was guided with the use of cone beam computerized tomography (O-Arm) to overcome difficulties with visualizing the cervicothoracic junction region. RESULTS: In addition to our case, we identified 52 cases of adult TCS from 34 articles. Patient age ranged from 18 to 73 (average 45.6) with male a predominance (n = 37, 71.2%). Neurological function on presentation was most commonly ASIA E (34.6%), followed by ASIA D (21.2%) and ASIA A (19.2%). The most frequently affected levels were C7-T1 (44.2%) followed by C6-7 (33.0%). Closed reduction was attempted in 42 (80.8%) patients. A total of 49 (94.2%) patients underwent surgical treatment, with 31 (63.3%) undergoing single-approach procedures. The presence of neurological injury, cervical level of injury, and age were not significant predictors of successful closed reduction. Similarly, successful closed reduction, age, cervical level of injury, and neurological injury were not predictors of a single-approach treatment. CONCLUSION: TCS is rare and most frequently appears at or near the cervicothoracic junction and in males. The presentation is typically that of severe neurological injury, but partial neurological recovery occurs in many patients. No predictors of successful closed reduction or single approach surgery are identified. We postulate that the use of intraoperative multiplanar imaging technology like the O-Arm may enhance the ability to achieve a successful closed reduction given the predilection for the injury to occur at the cervicothoracic junction. Prospective study of the durability of constructs by single or combined approaches is warranted.

Recommended Citation

Ng, C., Feldstein, E., Spirollari, E., Vazquez, S., Naftchi, A., Graifman, G., Das, A., Rawanduzy, C., Gabriele, C., Gandhi, R., Zeller, S., Dominguez, J. F., Krystal, J. D., Houten, J. K., & Kinon, M. D. (2022). Management and Outcomes of Adult Traumatic Cervical Spondyloptosis: A Case Report and Systematic Review. Journal of Clinical Neuroscience, 103, 34-40. https://doi.org/10.1016/j.jocn.2022.06.026