Systematic Review of Traumatic Thoracic Spondyloptosis and Presentation of a Novel Approach for Management With Quad Rod Construct. Issue 4 (18th October 2022)

• Record Type: Journal Article
• Authors: Anokwute, Miracle C.; House, Hanna; Huh, Andrew; Ordaz, Josue; McVeigh, Luke; Stockwell, David W.
• Is Part Of: Operative neurosurgery. Volume 23:Issue 4(2022)
• Page Start: e237
• Page End: e244
• Publication Date: 2022-10-18
• Subjects: Traumatic thoracic spondyloptosis -- Quad rod construct; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1227/ons.0000000000000338
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract : BACKGROUND: Traumatic thoracic spondyloptosis (TTS) is a rare but devastating spinal injury often secondary to high-impact trauma. TTS is typically managed with surgical fusion and stabilization. OBJECTIVE: To evaluate current surgical management of TTS while presenting a novel surgical technique for reduction and fusion. METHODS: We performed a systematic review of surgical management of TTS using Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data guidelines with 2 independent reviewers. We identified patient demographics, level of spondyloptosis, American Spinal Injury Association grade, level of spinal fusion, surgical approach, type of construct used, and reduction of fracture. RESULTS: Seventeen articles with 37 patients with TTS managed surgically were identified. The male:female ratio was 31:6. The average age was 33 years (±15). Motorized injury including motor vehicle accident, road traffic accident, and motor vehicle collision (16 patients, 43%) and fall including fall from height, stairs, train, or standing (16 patients, 43%) were equivalent. The middle (15 patients 40%) and lower (18 patients, 49%) thoracic regions were similar for the level of spondyloptosis. Thirty-four patients (92%) were American Spinal Injury Association A. Thirty-six patients (97.3%) underwent posterior only surgery and 1 (2.7%) underwent a combined posterior–anterior approach. There were 29 (78%) dual rod constructs and 8 (22%) dual rod with connectors or crosslinks. Complete reduction was obtained in 24 (65%) patients, incomplete in 11 (30%), and 2 (5%) patients were not reported. Two of our patients underwent novel quad rod reconstruction with complete reduction. CONCLUSION: Surgical management of TTS is typically posterior only with complete fracture reduction. We have presented a novel quad rod approach for reduction of TTS.