Novel method for stepwise reduction of traumatic thoracic spondyloptosis

BACKGROUND: Spondyloptosis involving complete subluxation of spinal vertebrae resulting in permanent spinal cord damage is rarely caused by high-force trauma. Rapid re-stabilization of the spine is crucial for maximizing chances of neural recovery and can significantly improve the patient's quality of life. In this case study, we describe the challenges associated with the surgical management of traumatic thoracic spondyloptosis, and propose a novel, safe, step-wise, spinal reduction method employing an inflatable beanbag. CASE DESCRIPTION: A 17-year-old male fell 25 feet from a tree, resulting in anterior spondyloptosis at the T11/12 level. He presented with para plegia and a T11 sensory level to pin below the umbilicus. Surgical management involved a posterior-anterior-posterior approach with initial posterior decompression, then T12 corpectomy and reconstruction and finally pedicle screw fixation. We utilized an inflatable beanbag to realign the spinal column in a stepwise fashion, thereby minimizing the risk of damage to the surrounding structures, including the thecal sac and great vessels. Postoperatively, the patient regained some sensory function below his injury level of T11 but remained plegic. X-ray imaging confirmed successful spinal fusion. CONCLUSION: Early spinal realignment and stabilization following spondyloptosis at the T11/T12 level resulted in some improvement in sensory function without resolution of motor plegia. Here, we described how to utilize a novel beanbag reduction method to safely achieve stepwise spinal realignment.