1Department of Neurosurgery, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Neurology and Neurosurgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia; 4Department of Surgery, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Surgery, Urology, Orthopedics, Physical and Rehabilitation Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Krapinske Toplice Special Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia; 7Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 8Department of Maxillofacial Surgery, Osijek University Hospital Centre, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia; 9Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 10Department of Neurosurgery, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Acta Clin Croat. 2020 Sep;59(3):555-559. doi: 10.20471/acc.2020.59.03.23.
A rare case of thoracolumbar spondyloptosis after a severe polytraumatic event is presented. Spondyloptosis accounts for a minor proportion of all spine trauma cases and is usually accompanied by complete neurological deficit. A 48-year-old man suffered severe polytrauma after having been hit by a truck at the work place. Radiographic scanning revealed multiple traumatic injuries and spondyloptosis at the L1/L2 level in coronal plane. However, despite extensive injuries, ASIA score was estimated as D. The patient underwent urgent multidisciplinary surgery due to severe head injuries. The next surgery was performed to stabilize the thoracolumbar segment and to preserve neurological functions. The surgery included implantation of transpedicular titanium screws posterior approach. Good postoperative recovery was achieved during early postoperative rehabilitation at our Department, which was estimated as ASIA score D. In conclusion, prompt operative treatment to achieve neural integrity and early rehabilitation should be considered as the gold standard in such complicated injuries. Postoperative recovery largely depends on the quality of rehabilitation, which leads to improvement of patient self-care and normal social and psychological functions. In our case, the good preoperative neurological status of the patient also contributed to better postoperative outcome.
本文报告了一例罕见的严重多发创伤后胸腰椎滑脱病例。脊柱创伤中,脊柱滑脱占比较小,且通常伴有完全性神经功能缺损。一名 48 岁男性在工作时被卡车撞击后发生严重多发创伤。影像学扫描显示冠状面 L1/L2 水平存在多处创伤性损伤和脊柱滑脱。然而,尽管存在广泛的损伤,ASIA 评分为 D。由于严重的头部损伤,患者接受了紧急多学科手术。下一次手术是为了稳定胸腰椎段并保留神经功能。手术包括后路经椎弓根钛螺钉植入。在我们科进行早期术后康复期间,患者术后恢复良好,ASIA 评分为 D。总之,对于此类复杂损伤,应考虑及时手术治疗以实现神经完整性和早期康复,这是治疗此类损伤的金标准。术后恢复在很大程度上取决于康复质量,这有助于改善患者的自理能力以及正常的社会和心理功能。在我们的病例中,患者术前良好的神经功能状态也有助于获得更好的术后结果。