C3-C4 spondyloptosis without neurological deficit-a case report

Area of Science:

• Orthopedics
• Neurosurgery
• Spinal Surgery

Background:

• Traumatic spondyloptosis of the cervical spine typically presents with significant neurological deficits.
• Bipedicular fracture of the C3 vertebra with spondyloptosis is an uncommon injury pattern.
• Management strategies for neurologically intact patients with cervical spondyloptosis remain unclear.

Observation:

• A 35-year-old male sustained a hyperextension-compression injury resulting in C3-C4 spondyloptosis and C1-C3 posterior element fractures.
• The patient presented with no neurological deficit despite the severe cervical spine injury.
• Treatment involved awake nasotracheal intubation, gradual cervical traction, and anterior cervical fusion at C3-C4.

Findings:

• Complete fusion at the C3-C4 level and healing of C1-C2 fractures were achieved within 24 months.
• The patient remained asymptomatic with a normal neurological examination and maintained near-complete cervical range of motion.
• The patient successfully returned to pre-injury work and recreational activities.

Implications:

• Cervical spondyloptosis, even with associated fractures, can occur without neurological compromise.
• Gradual reduction under fluoroscopic guidance is a viable treatment option for neurologically intact patients.
• Limited anterior fusion at the spondyloptosis level can ensure spinal stability while preserving motion in adjacent segments, leading to favorable long-term results.