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\begin{document}

\title{Successful management of traumatic cervical spondyloptosis with
incomplete neurological deficit in a child: A case report}



\author[1]{Ousmane Ouattara}%
\author[1]{Ibrahim DAO}%
\author[1]{Narcisse Wendpuiré Mike  OUEDRAOGO}%
\author[1]{Souleymane OUEDRAOGO}%
\author[2]{Massadiami Soulama}%
\author[3]{Malick Diallo}%
\author[2]{Patrick Dakouré}%
\affil[1]{University Hospital Sanou Souro}%
\affil[2]{Universite NAZI BONI}%
\affil[3]{Centre Hospitalier Universitaire Sanou Souro}%


\vspace{-1em}



  
  \date{June 02, 2024}


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\textbf{Manuscript Body}

\textbf{Introduction}

Spondyloptosis is a condition in which there is complete slippage of one
vertebral body over the corpus of the adjacent one {[}1{]}. It's
correspond to the Grade V of Meyerding's classification of
spondylolisthesis {[}2{]}. This pathology is more common in the lumbar
region of the spine but subaxial cervical spondyloptosis is extremely
rare. It can be seen after trauma, or in the course of neoplastic or
congenital diseases {[}3{]}. Traumatic cervical spine spondyloptosis
(TCS) is one of the least discussed forms of cervical spine traumatisms
because of its rarity and the gravity of patient's condition, limiting
good management. Moreover, there is a lack of data reporting, especially
in developing countries {[}2{]}. Management of cervical spondyloptosis
represents a challenge to all spine care specialists. Here we report a
case of post-traumatic posterior C5--C6 spondyloptosis with incomplete
neurological deficit which was managed successfully by anterior
approach.

\textbf{Case history/ examination}

A 14-years-old male patient was transferred to the surgery department of
Sour\selectlanguage{ngerman}ô Sanou teaching hospital from a peripheral hospital after falling
from a tree 15 hours ago. He complained of neck pain with weakness in
all four limbs. A cervical collar was applied before the transfer. He
was conscious and vital parameters such as respiratory rate, pulse rate,
blood pressure and oxygen saturation where within normal limits.
Neurological examination revealed a tetraparesia below the level of C5.
Muscle power in all four limbs was Grade 3/5 except both deltoids where
muscle power was normal. Skin sensation, bladder and bowel function were
preserved. Her preoperative American Spinal Injury Association (ASIA)
Impairment Scale was D. There were no associated injuries to the chest,
abdomen and pelvis.

\textbf{Methods (Diagnosis, investigations and treatment)}

\textbf{Diagnosis and Investigations:} Computed tomography of the neck
objectified a posterior C5--C6 spondyloptosis allowed by a bipedicular
fracture of C6 {[}Figure 1A\selectlanguage{english}-B{]}. An anterior spondylolisthesis of
C7-T1with bipedicular fracture of C7 were also found. No facet joint
dislocation was present. Two fragments were detached from C6 and C7 body
and reduced the spinal canal. There was a C5 anterior body fracture.
Magnetic resonance imaging was not available.

\textbf{Treatment:} Surgical intervention was done by anterior approach
only seven days after the trauma without preoperative cervical traction.
The patient underwent a two level cervical corpectomy (C6-C7) with iliac
crest fusion and rigid plate fixation. Patient was placed at supine
position under general anesthesia. Oblique incision along the medial
border of the right sternocleidomastoid muscle was given. After reaching
to the injured area, the traumatized vertebral bodies of C6 and C7 were
removed using Kerrison rongeur and bone-gouge forceps. The injured
posterior longitudinal ligament was also removed and complete
decompression of the cord was achieved. Tricortical iliac crest bone
graft was placed in the corpectomy defect after applying manual
traction. A rigid plate was fixed from C4 to T1 with two screws on C4,
one screw on the bone graft and two screws on T1 {[}Figure 2A\selectlanguage{english}-B{]}.
Corporeal fracture of C5 didn't allow to put screws there.

\textbf{Conclusion and Results (Outcome and follow-up)}

No new neurological deficit was noted after surgery. Cervical collar was
applied and seven days after surgery, muscular power improved to Grade
5/5 in both lower limbs. Patient was discharged home on the 10th post-
operative day. He recovered completely after 2 months (Normal muscle
strength in all limbs). At the operated area, an intervertebral fusion
was noted at the third month follow - up with intact implant assembly
{[}Figure 3A-B{]}.

\textbf{Discussion}

The term spondyloptosis is made of spondylo and ptosis words and is used
when the vertebrae slips and falls down totally in front of lower corpus
from its original anatomical level {[}3{]}. It is more common in the
lumbar spine than in the cervical spine and can be seen following birth
trauma, congenital conditions of the cervical spine (like absent
cervical pedicles or corticated defect in pars interarticularis),
neoplastic diseases (like neurofibromatosis or aneurysmal bone cyst) and
after vehicle or diving trauma {[}4{]}. Traumatic cervical spine
spondyloptosis is a very rare entity and is considered the most severe
form of cervical spine injuries {[}5{]}. A systematic review published
in 2023 was reported only 66 cases {[}2{]}. The incidence of cervical
spine spondyloptosis is probably underestimated basing on the fact that
most of patients present this severe lesion haven poor outcomes limiting
the good management and so the presentation of the cases. This lack of
data reporting is more pronounced in developing countries {[}1{]}. The
etiology of his spondyloptosis was a fall from a tree. Falls from trees
related traumas are rarely reported in literature. But, they are public
health problems in developing countries where their frequency is still
important. These falls concern particularly children with mean age of 14
years {[}6{]}.

Traumatic Cervical Spondyloptosis (TCS) is an unstable injury due to
complete distruption of all ligamanter structures involving three
columns {[}5{]}. The case described in this report was a posterior form
of spondyloptosis and located at the C5--C6 level. Concerning location,
approximately two-third of all fractures, and three-fourth of all
dislocations involve the subaxial cervical spine {[}7{]}. Dislocations
occur most commonly at C5---C6 and C6---C7 levels {[}8{]}. This segment
of the spine is highly vulnerable to injury as it is greatly mobile and
at the proximal end it carries the weight of the head. Moreover, it has
to bear great amount of force in acceleration and deceleration injuries
{[}8{]}. Posterior form of TCS, as in our case is very rare and it is
seen in only 10\% of cases. The anterior slippage of the superior
vertebrae (anterolisthesis) is the dominated form in more than 83\% of
cases; whereas only one case (1.5\%) of laterolisthesis was reported
{[}2{]}.

Clinical presentation varies in the literature. According to Khelifa
and\emph{al} ., one\selectlanguage{english}-third of reviewed patients are received initially
without any neurologic deficit and one\selectlanguage{english}-third with incomplete motor
deficit, whereas only 36\% of patients are totally paralytic {[}2{]}.
Our patient had an incomplete neurological deficit. It may explain by
the pattern of lesion. In fact, there was a total rupture between
anterior and posterior elements (bipedicular fracture) at the level of
C6 and C7. That led to a spontaneous decompression of the spinal canal.

Concerning medical imaging, computed tomography (CT) is important to
identify a spondyloptosis with the associated bone lesions and to plan
management strategy. Exploring arterial posttraumatic lesions with
either angiography or angio\selectlanguage{english}-CT must be done to research vertebral artery
lesions (pseudoaneurysm, dissection). Magnetic Resonance Imaging (MRI)
is very useful in detecting associated soft tissues lesions, especially
spinal cord compression, ligamentous rupture, and disk hernia, which led
surgeons to prefer starting with anterior decompression before posterior
reduction or stabilization {[}5{]}. Magnetic Resonance Imaging was not
available in our hospital, but computed tomography haven permitted to
establise the diagnosis of cervical spondyloptosis with ventral
compression of spinal cord. Angio-CT sequences was not available also.

The ultimate goal of treatment in cervical spondyloptosis is to obtain
anatomic alignment, neural decompression, and to prevent further
instability with a solid fusion {[}9{]}. Like any other instable
cervical spine lesions, it is an emergency. But our case is managed nine
days after the trauma. This delay is due to the fact that costs of
health care are borne by the family and they took time to gather
surgical kit. Management of cervical spondyloptosis in case of
incomplete injury or normal neurological status at presentation
represents a challenging clinical scenario for the clinician.

There is no definite consensus when it comes to the management of TCS.
Concerning preoperative closed cervical traction, some authors think
that it could compromise neurologic function by compression of the
spinal cord. This compression would be due to retropulsion of the disc
into the spinal canal during traction {[}3,10{]}. However, other reports
think that cervical traction can be safely implemented in spondyloptosis
patients because spinal canal was decompress by fractures of the
posterior elements {[}4,11{]}. In our case there was anterior
compression of spinal cord by bone fragment. So closed cervical traction
was not indicated due to risk of neurological deterioration.

Surgical management options described in the literature ranging from a
simple anterior or posterior approach to 540-degree fusion {[}12{]}. An
anterior and posterior fusion is the standard management due to greater
realignment and stabilization being achieved in unstable injuries, with
all ligamentous structures involving the three columns {[}4{]}. No
significant differences were observed between the anterior\selectlanguage{english}-only,
posterior\selectlanguage{english}-only, and 360deg repair groups regarding immediate postoperative
ASIA grade and ASIA grade at the end of the follow\selectlanguage{english}-up period {[}13{]}.
In our case, we have indicated ventral surgery in accordance with the
location of the compression. Some authors have demonstrated that
anterior-only fusion might suffice in selected patients with cervical
spondyloptosis {[}14,15{]}.

Our patient had an excellent short-term neurologic and functional
recovery. This supports the view that anterior ventral surgery alone can
be used with success in the management of cervical spondyloptosis in
selective cases.

\textbf{Conclusion}

Traumatic cervical spondyloptosis is a rare injury and can involve
children. Clinical presentations varied to neurologically intact to
quadriplegia. Computed tomography is the imaging exploration of choice
in developing countries where Magnetic Resonance Imaging (MRI) was
difficult to access. Presently, no consensus is present regarding the
best treatment for spondyloptosis. Satisfactory clinical and good
outcome can be obtained by anterior cervical corpectomy and fusion in
some cases.

\textbf{KEYWORDS:} Trauma, Spine, Neurosurgery, Pediatric.

\textbf{Authorship Contribution}

\textbf{Author 1: Ousmane OUATTARA (corresponding
author):}Conceptualization of the original idea and writing -- original
draft

\textbf{Author 2: Ibrahim DAO:} Conceptualization of the original idea
and contribution to the final version of the manuscript

\textbf{Author 3: Narcisse Wendpuire Mike OUEDRAOGO:} Conceptualization
of the original idea and contribution to the final version of the
manuscript

\textbf{Author 4: Souleymane OUEDRAOGO:} Conceptualization of the
original idea and contribution to the final version of the manuscript

\textbf{Author 5: Massadiami SOULAMA:} Conceptualization of the original
idea and contribution to the final version of the manuscript

\textbf{Author 6: Malick DIALLO:} Conceptualization of the original idea
and contribution to the final version of the manuscript

\textbf{Author 7: Patrick Wendpouire Hamed DAKOURE:} Conceptualization
of the original idea and contribution to the final version of the
manuscript

\textbf{ACKNOWLEDGEMENT:} None



\textbf{References}

1. Modi JV, Soman SM, Dalal S. Traumatic Cervical Spondyloptosis of the
Subaxial Cervical Spine\selectlanguage{english} : A Case Series with a Literature Review and a
New Classification. \emph{Asian Spine J} . 2016;10(6):1058-1064.

2. Khelifa A, Berchiche L, Aichaoui F, Lagha N, Asfirane N, Morsli A.
Traumatic cervical spine spondyloptosis\selectlanguage{english} : A systematic review. \emph{J
Craniovert Jun Spine} . 2022;13:9-16.

3. Keskin F, Kalkan E, Erdi F. The Surgical Management of Traumatic
C6-C7 Spondyloptosis. \emph{J Korean Neurosurg Soc} . 2013;53:49-51.

4. Choi M, Jo D, Kim M, Kim T. Management of Traumatic C6 -- 7
Spondyloptosis with Cord Compression. \emph{J Korean Neurosurg Soc} .
2014;55(5):289-292.

5. Tsujimoto T, Suda K, Matsumoto S, et al. Two case reports of ` locked
spondyloptosis '\selectlanguage{english} : the most severe traumatic cervical spondyloptosis
with locked spinous process and vertebral arch into the spinal canal
Case presentation. \emph{Spinal Cord Ser Cases} . 2020;6:2-6.

6. Dakoure PWH, Diallo M, Traore A V, et al. Trauma related to falls
from trees treated in a specialized trauma centre in Burkina-Faso ---
one hundred and six cases treated in one year. \emph{Int Orthop} .
2015;39:2451-2456.

7. Zaveri G, Das G. Management of Sub-axial Cervical Spine
Injuries.\emph{Indian J Orthop} . 2017;51:633-652.

8. Barbar N, Kumar N, Kumar R, Sharma A, Choudhary MC. Spondyloptosis at
Subaxial Cervical Spine with Minimal Neurological Compromise and
Complete Recovery\selectlanguage{english} : A Rare Case Report. \emph{J Orthop Case Rep} .
2022;12:118-121.

9. Chadha M, Singh AP, Singh AP. Spondyloptosis of C6-C7: a rare case
report. \emph{Chinese J Traumatol English Ed} . 2010;13(6):377-379.

10. Tumiala LM, Dadashev V, Laborde D V, Gupta SK. Management of
Traumatic Cervical Spondyloptosis in a Neurologically Intact
Patient.\emph{Spine} . 2009;34(19):703-708.

11. Merianos P, Manousidis D, Samsonas P, Baltopoulos P, Pateras N,
Mavroudis G. Injuries of the lower cervical spine associated with
widening of the spinal canal. \emph{Injury} . 1994;25(10):645-648.

12. Inder H, Rai S, Garg K, Agrawal D. Management of Traumatic Cervical
Spondyloptosis. \emph{Indian J Neurotrauma} . 2021;0:1-5.

13. Wong KE, Chang PS, Monasky MS, Samuelson RM. Traumatic
spondyloptosis of the cervical spine\selectlanguage{english} : A case report and discussion of
worldwide treatment trends. \emph{Surg Neurol Int} . 2017;8:89.

14. Oraee-yazdani S, Golmohammadi M, Akhlaghpasand M, Oraee-Yazdani M. A
Three approach at one stage to surgical management of Cervical
Spondyloptosis after Failed Primary anterior fusion. \emph{J Neurosci
Neurol Disord} . 2018;2:98-100.

15. Srivastava SK, Agrawal KM, Sharma AK, Agrawal MD, Bhosale SK,
Renganathan SR. C3 -- C4 spondyloptosis without neurological deficit ---
a case report. \emph{Spine J} . 2010;10(7):e16-e20.

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