T12-L1 telescoped chronic dislocation treated by en bloc one-piece spondylectomy and spine shortening

The author presents a case in which a severe chronic thoracolumbar kyphotic posttraumatic deformity was corrected by a one-block spondylectomy with spine shortening, using a posterior approach. A 19-year-old paraplegic woman was admitted with a chronic deformity of the thoracolumbar spine due to a telescoped posterior dislocation of L1 on T12, which had occurred 8 months earlier. Single reduction by axial traction was impossible. Surgical correction was achieved by means of a total, one-block, L1 spondylectomy and end-to-end apposition of the T12 inferior platform onto the L2 superior platform. This was performed through a posterior approach. The reduction was fixed by a pedicular instrumentation extended from T10 to L4. To our knowledge, this is the first documented case in which the spondylectomy was performed in a single block including the vertebral body and posterior arch in the same piece. Five years following surgery, the clinical result is excellent with complete correction of the deformity and solid interbody vertebral fusion. The complete transection of the spinal cord permitted this aggressive approach, which would have not been possible in other types of pathology.