Xu Feng, Tian Zhisen, Fu Changfeng, Yao Liyu, Yan Mengjie, Zou Congcong, Liu Yi, Wang Yuanyi
Department of Spine Surgery, The First Hospital of Jilin University.
Department of Orthopedics, China-Japan Union Hospital Affiliated to Jilin University.
Medicine (Baltimore). 2020 Mar;99(12):e19578. doi: 10.1097/MD.0000000000019578.
Spondyloptosis is a form of vertebral dislocation and the most advanced form of spondylolisthesis. Traumatic spondyloptosis is usually caused by high-energy impact and results in unstable spine deformity and spinal canal deformation, which lead to severe spinal cord injury. Traumatic spondyloptosis is mostly reported in the lumbo-sacral junction, while it is rarely documented in mid-lumbar segments. To the best of the authors' knowledge, only 16 cases of mid-lumbar spondyloptosis have been described previously. Herein, we present a L3 to L4 spondyloptosis case that did not involve neurological deficit.
A 42-year-old man presented to the emergency department after an accident involving a fall. The patient developed severe back pain and spinal deformity, while his neurologic function remained intact. Radiological examinations indicated complete posterior vertebral dislocation at L3 to L4 and a fracture at the bilateral pelvic ischial tuberosity without major vessel injury or severe dura sac compression.
L3 to L4 complete vertebral dislocation, pelvic ischial tuberosity fracture.
For treatment, the patient underwent fracture reduction, L3 to L4 intervertebral fusion, and internal fixation 7 days post-injury.
Postoperative digital radiography showed the correction of the spinal deformity. The patient was pain-free and fully rehabilitated 3 months after the surgery. At the 1-year follow-up, the patient was completely asymptomatic and had achieved normal alignment.
We reported an L3 to L4 traumatic spondyloptosis case that involved intact neurology, which is the first-ever reported mid-lumbar spondyloptosis case that involved complete posterior column and neural sparing. For the treatment of traumatic spondyloptosis without neurological deficit, restoring stability and preventing secondary cord injury should be taken into consideration.
椎体滑脱是椎体脱位的一种形式，也是腰椎滑脱最严重的形式。创伤性椎体滑脱通常由高能冲击引起，导致脊柱不稳定畸形和椎管变形，进而引发严重的脊髓损伤。创伤性椎体滑脱多报道于腰骶交界处，而在腰椎中段则鲜有记录。据作者所知，此前仅描述过16例腰椎中段椎体滑脱病例。在此，我们报告一例L3至L4椎体滑脱病例，该病例未伴有神经功能缺损。
一名42岁男性在一次摔倒事故后被送往急诊科。患者出现严重背痛和脊柱畸形，但其神经功能保持完好。影像学检查显示L3至L4椎体完全后脱位，双侧坐骨结节骨折，未伴有大血管损伤或严重硬脊膜囊受压。
L3至L4椎体完全脱位，坐骨结节骨折。
为进行治疗，患者在受伤7天后接受了骨折复位、L3至L4椎间融合及内固定手术。
术后数字X线摄影显示脊柱畸形得到矫正。患者术后3个月时疼痛消失且完全康复。在1年随访时，患者完全无症状，脊柱排列恢复正常。
我们报告了一例L3至L4创伤性椎体滑脱病例，该病例神经功能完好，这是首例报道的涉及完整后柱且神经未受损的腰椎中段椎体滑脱病例。对于治疗无神经功能缺损的创伤性椎体滑脱，应考虑恢复稳定性并预防继发性脊髓损伤。
