Cervical
Spondyloptosis: Case reports and review of the literature
Biodun
Ogungbo, Consultant Neurosurgeon, Cedarcrest Hospital, Abuja, Nigeria
OBJECTIVES:
To
present nine cases of patients with traumatic cervical spondyloptosis managed
in Abuja. The management protocol and outcome may prove instructive in managing
patients with this severity of injury to the cervical spinal cord.
MATERIALS AND METHOD
Nine
patients with cervical spondyloptosis presented to the unit. These are consecutive
patients in a cohort of patients with spinal trauma managed by a single
neurosurgeon from August 2009 to date. We collected data on the demographics,
presentation, radiology, management and recent outcomes on these patients.
Pre-operative and post-operative Frankel grades within 48 h were recorded.
Final outcome, evaluated using the Bathel disability index, was scored by 30
September 2011.
RESULTS
Nine
patients had severe vertebral dislocations (grade 4), bifacetal dislocations
and fractures of the posterior elements. All underwent anterior cervical
discectomy and fusion as a first step. Two underwent additional posterior
fixation with soft wires and bone grafts. We were unable to achieve
satisfactory reduction in two patients. Both were plated insitu anteriorly. One
was stable and the other re dislocated within two weeks. He subsequently died. Four
more have died as at last follow up review. Remaining patients are quadriplegic
and only one has been satisfactorily rehabilitated, and socially functional.
CONCLUSIONS
Spondyloptosis of the
cervical spine is not a rare injury in Nigeria. Traumatic cervical
spondyloptosis was associated with complete and irreversible spinal cord
injury. Post operative care is intensive and fraught with dangers such as pyrexia,
hypotension and hypoxia. The risks of
death are high within 2 months of the operation. These patients are extremely difficult to manage especially in
resource poor communities.
KEY WORDS: Anterior cervical discectomy, cervical spine
traumatic instability, Cervical Spondyloptosis, Nigeria, Outcome, Surgical
fixation, Trauma
Hello Boss, just reading your review of spondyloptosis. I have operated about five patients and lost one due to intestinal perforation and he died while having explorative laparotomy. In my centre, i just do a 360 fixation for them (cerclage wiring after posterior decompression and ACDF) Guess will could get together sometimes and we could have a multi center review.
ReplyDeleteTayo Ojo
LUTH
Cervical spine surgery in India is providing very economical and reasonable charges as compared to any other country mean now people don’t have to worry regarding cost.
ReplyDeleteFor the patients who are facing the relative cervical issues and wants the treatment within the reliable cost as offered by the Spine Surgery India and that too must be associative with the better cervical spine surgery cost in India that is much more affordable for the patients who are thinking of such treatments within the suitable amount.
ReplyDeleteDr. Gurneet Singh Sawhney is one of the best Neurosurgeon in Mumbai, India. He is working as consultant Neurosurgeon at Fortis Hospital (Mulund & Vashi).
ReplyDelete