Tracz Jovanna A, Judy Brendan F, Sacino Amanda N, Bydon Ali, Witham Timothy F
J Neurosurg Case Lessons. 2022 Jul 18;4(3):CASE22221. doi: 10.3171/CASE22221.
Grade V spondylolisthesis, or spondyloptosis, is a complication of high-energy trauma that is most commonly reported at the lumbosacral junction. Sacral intersegmental spondyloptosis is extremely rare. The authors present a case of spondyloptosis of S1 on S2 with a comminuted fracture of S2 and complex fractures of the L4 and L5 transverse processes, resulting in severe stenosis of the lumbosacral nerve roots.
The patient was a 70-year-old woman with a history of a fall 3 weeks prior and progressive L5 and S1 radiculopathy. Instrumentation and fusion were undertaken, extending from L3 to the pelvis because degenerative stenosis at L3-4 and L4-5 was also found. Reduction was achieved, leading to diminished pain and partial resolution of weakness.
Traumatic sacral spondyloptosis adds a degree of difficulty to reduction, fixation, and fusion. The technique presented herein achieved sagittal realignment via a distraction maneuver of S1-2 in which rods were attached to bilateral dual S2 alar-iliac screws with reduction screws placed at S1, ultimately pulling L5 and S1 up to the rod for fixation.
V 度椎体滑脱，即椎体后移，是高能创伤的一种并发症，最常见于腰骶交界处。骶骨节段间椎体后移极为罕见。作者报告了一例 S1 相对于 S2 的椎体后移病例，伴有 S2 粉碎性骨折以及 L4 和 L5 横突复合骨折，导致腰骶神经根严重狭窄。
患者为一名 70 岁女性，有 3 周前跌倒史，伴有进行性 L5 和 S1 神经根病。由于还发现 L3 - 4 和 L4 - 5 存在退行性狭窄，遂进行了从 L3 至骨盆的内固定和融合手术。实现了复位，疼痛减轻，无力症状部分缓解。
创伤性骶骨椎体后移增加了复位、固定和融合的难度。本文介绍的技术通过 S1 - 2 的撑开操作实现矢状面重新对线，其中将棒连接到双侧双 S2 翼状髂骨螺钉，并在 S1 处放置复位螺钉，最终将 L5 和 S1 向上拉至棒上进行固定。
