Vazquez Sima, Houten John K, Stadlan Zehavya T, Greisman Jacob D, Vaserman Grigori, Spirollari Eris, Sursal Tolga, Dominguez Jose F, Kinon Merritt D
Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, United States.
Surg Neurol Int. 2023 Sep 1;14:304. doi: 10.25259/SNI_360_2023. eCollection 2023.
Traumatic spondyloptosis (TS) with complete spinal cord transection and unrepairable durotomy is particularly rare and can lead to a difficult-to-manage cerebrospinal fluid (CSF) leak.
We performed a systematic review of the literature on TS and discuss the management strategies and outcomes of TS with cord transection and significant dural tear. We also report a novel case of a 26-year-old female who presented with thoracic TS with complete spinal cord transection and unrepairable durotomy with high-flow CSF leak.
Of 93 articles that resulted in the search query, 13 described cases of TS with complete cord transection. The approach to dural repair was only described in 8 ( = 20) of the 13 articles. The dura was not repaired in two (20%) of the cases. Ligation of the proximal end of the dural defect was done in 15 (75%) of the cases, all at the same institution. One (5%) case report describes ligation of the distal end; one (5%) case describes the repair of the dura with duraplasty; and another (5%) case describes repair using muscle graft to partially reconstruct the defect.
Suture ligation of the thecal sac in the setting of traumatic complete spinal cord transection with significant dural disruption has been described in the international literature and is a safe and successful technique to prevent complications associated with persisting high-flow CSF leakage. To the best of our knowledge, this is the first report of thecal sac ligation of the proximal end of the defect from the United States.
创伤性椎体滑脱（TS）合并脊髓完全横断和不可修复的硬脊膜切开术极为罕见，可导致难以处理的脑脊液（CSF）漏。
我们对有关TS的文献进行了系统综述，并讨论了TS合并脊髓横断和严重硬脊膜撕裂的管理策略及结果。我们还报告了一例新病例，一名26岁女性，表现为胸段TS合并脊髓完全横断和不可修复的硬脊膜切开术及高流量CSF漏。
在检索到的93篇文章中，13篇描述了TS合并脊髓完全横断的病例。13篇文章中只有8篇（约20%）描述了硬脊膜修复方法。2例（20%）未进行硬脊膜修复。15例（75%）在同一机构对硬脊膜缺损近端进行了结扎。1例（5%）病例报告描述了对远端进行结扎；1例（5%）病例描述了用硬脑膜成形术修复硬脊膜；另一例（5%）病例描述了用肌肉移植修复以部分重建缺损。
国际文献中已描述了在创伤性脊髓完全横断合并严重硬脊膜破裂的情况下对硬脊膜囊进行缝合结扎，这是一种预防持续性高流量CSF漏相关并发症的安全且成功的技术。据我们所知，这是美国首例关于对缺损近端硬脊膜囊进行结扎的报告。
