Posterior Realignment and Anterior Column Reconstruction of Thoracic Spondyloptosis Using Intraoperative CT and Navigation: Case Report and Review of the Literature.
Ismail Zaed, Dominique E Kuhlen, Francesco Marchi
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Case in brief
An 18-year-old man presented after a motorcycle collision with complete paraplegia and a T4 sensory level (AIS A). CT showed T5–T6 spondyloptosis with translation, rotation, vertebral comminution, and complete spinal-column disruption; MRI demonstrated severe cord distortion, T2 hyperintensity, and an epidural hematoma. He underwent single-stage posterior decompression, hematoma evacuation, progressive realignment, and anterior-column reconstruction with an interbody cage, guided by repeated intraoperative CT and navigation. Postoperative imaging showed satisfactory reconstruction, with no perioperative complication. Neurological status remained unchanged at 5-year follow-up.
What made this case unusual
Repeated intraoperative CT and navigation were used to reassess anatomy as it changed during realignment and to verify screw placement, cage position, and final alignment in this severe thoracic injury.
Diagnostic / clinical pearl
In severe spondyloptosis, major anatomical distortion can change during reconstruction; iterative intraoperative imaging may help guide instrumentation and confirm alignment, although comparative data are lacking.