Setiawan Eko, Husin Syafruddin, Shihab Muhammad Quraish, Pribadi Bayu Pratama Putra, Wiranata Muhammad, Prasetiyo Gregorius Thomas
Department of Surgery, Division of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia; Division of Orthopaedic and Traumatology, Arifin Achmad General Hospital, Pekanbaru, Indonesia.
Department of Surgery, Division of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia; Division of Orthopaedic and Traumatology, Arifin Achmad General Hospital, Pekanbaru, Indonesia.
Int J Surg Case Rep. 2024 Jul;120:109703. doi: 10.1016/j.ijscr.2024.109703. Epub 2024 Apr 24.
A fracture-dislocation of the vertebral bone is mostly caused by high-energy trauma. Spondyloptosis is the severest form of spondylolisthesis (>100 %) which affects the sagital or coronal plane from the contiguous vertebral bone. Anterior spondyloptosis is known as fracture-dislocation where the proximal part of the vertebra is located infront of the distal vertebrae. Most cases are associated with spinal cord injury (SCI) and unstable hemodynamics, in this case the vital sign of the patient's tend to be stable.
A 21-year-old man had multiple traumas after having a traffic injury, pain and numbness were positive during physical examination, especially in both lower limb. A radiography examination shows that the patient had total spinal cord transection and anterior spondyloptosis in T12 until L1 segment. Additional examinations found minimal renal and liver contusion including the ischemic bowel. The interbody fusion procedure was chosen as our therapeutic modalities.
We performed open surgical methods by using interbody fusion modalities usually in patient's with stable vital signs. This intervention could be the priority in managing patients with a rare case of anterior spondyloptosis. A visual analog Scale (VAS) was used for monitoring the degree of pain, and Oswestry Disability Index (ODI) questionnaire for evaluating the outcome for low back pain.
Most traumatic spondyloptosis cases end with neurogenic shock, Due to the injury's rarity and collaborated with minimal soft tissue injury, early diagnosis and the use of an open surgical method may improve patient's outcome.
椎体骨折脱位大多由高能量创伤引起。椎体滑脱是脊柱滑脱最严重的形式(>100%),影响相邻椎体的矢状面或冠状面。前位椎体滑脱即骨折脱位,椎体近端位于远端椎体前方。大多数病例伴有脊髓损伤(SCI)和血流动力学不稳定,而在这种情况下患者的生命体征往往稳定。
一名21岁男性在交通伤后受到多处创伤,体格检查时疼痛和麻木呈阳性,尤其是双下肢。X线检查显示患者在T12至L1节段有完全性脊髓横断和前位椎体滑脱。进一步检查发现有轻微肾和肝挫伤以及缺血性肠损伤。选择椎间融合手术作为我们的治疗方式。
我们通常对生命体征稳定的患者采用椎间融合方式进行开放手术。对于罕见的前位椎体滑脱病例,这种干预可能是治疗患者的首要选择。采用视觉模拟评分法(VAS)监测疼痛程度,采用奥斯威斯残疾指数(ODI)问卷评估腰痛的治疗效果。
大多数创伤性椎体滑脱病例以神经源性休克告终,由于这种损伤罕见且合并的软组织损伤轻微,早期诊断并采用开放手术方法可能改善患者的治疗效果。