Traumatic spondyloptosis of the lumbar spine: closed reduction and internal fixation.

STUDY DESIGN: Case report.

OBJECTIVE: To describe a novel approach to treating traumatic spondyloptosis of the lumbar spine.

SUMMARY OF BACKGROUND DATA: Traumatic spondyloptosis of the lumbar spine is a relatively uncommon injury because it requires a significantly large amount of energy to occur. Reduction of these fracture dislocations in the operating room may be difficult through a solely open approach because it usually requires a significant degree of bone removal and spinal manipulation with instrumentation.

METHODS: In this case report, the authors present a unique method of closed reduction followed by open fixation of a traumatic fracture dislocation of the lumbar spine. The patient in this study experienced a traumatic spondyloptosis of L3 on L4 from a high-speed motor vehicle crash in which he was ejected from the vehicle. The patient had experienced nearly complete anterior/posterior translocation of L3 on L4 and had avulsed the anterior superior aspect of the L4 vertebral body. On presentation to the trauma center, he was ASIA (American Spinal Injury Association) B; he had patchy sensory preservation in his left lower extremity. The surgical goal was to relocate his spinal fracture and rigidly fix it with a pedicle screw and rod construct.

RESULTS: Under fluoroscopic guidance and with the patient under general anesthesia, we performed a closed reduction of the spinal fracture using lumbar hyperextension and full torso longitudinal traction. We were able to reduce the fracture almost completely using this technique. After open internal fixation of the patient's fracture with a rod-pedicle screw construct, we reduced the patient's fracture to a grade II spondylolisthesis, effectively. The patient went on to recover a small amount of neurological function after the procedure.

CONCLUSION: The authors think that this is an effective method for reduction of these severe fractures.