Cabrera Juan P, Yankovic Willy, Luna Francisco, Torche Esteban, Valdés Guillermo, López Eduardo, Chávez Oriana
Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.
University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile.
Trauma Case Rep. 2019 Oct 31;24:100248. doi: 10.1016/j.tcr.2019.100248. eCollection 2019 Dec.
High-energy traumas frequently result in lumbar spine fractures such as spondyloptosis is the maximum expression of instability and severity. The management of spondyloptosis is complex and, essentially, surgical. It usually presents with irreversible neurological compromise. This paper aimed to present a case of lumbar spondyloptosis and its early confrontation, partial neurological involvement, and progressive postoperative retrieval.
A male patient aged 42 years had multiple injuries with asymmetric paraparesis and sphincter involvement. Computed tomography (CT) revealed L3 vertebral spondyloptosis detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. Surgical resolution was defined by performing an en bloc corpectomy through lumbotomy and the installation of an expandable cage with posterior transpedicular fixation of L2-L4, thereby recovering the spinal canal diameter, lumbar lordosis, sagittal balance, and improving motor function progressively.
Complex spinal injuries warrant an early resolution by a trained surgical team to ensure normal spinal parameters and to achieve a progressive neurological recovery.
高能创伤常导致腰椎骨折,如椎体滑脱是不稳定和严重程度的最大表现。椎体滑脱的治疗复杂,本质上是手术治疗。它通常伴有不可逆的神经功能损害。本文旨在介绍一例腰椎椎体滑脱病例及其早期应对、部分神经受累情况和术后逐渐恢复的过程。
一名42岁男性患者多处受伤,伴有不对称性双下肢轻瘫和括约肌受累。计算机断层扫描(CT)显示L3椎体滑脱,与脊柱其他部分分离,椎管狭窄,矢状面失衡和角状后凸。手术方案是通过腰椎切开术进行整块椎体切除术,并安装可扩张椎间融合器,同时对L2 - L4进行后路椎弓根固定,从而恢复椎管直径、腰椎前凸、矢状面平衡,并逐渐改善运动功能。
复杂的脊柱损伤需要由训练有素的手术团队尽早解决,以确保脊柱参数正常,并实现神经功能的逐渐恢复。