The Surgical Management of Traumatic C6-C7 Spondyloptosis
A 51-year-old female patient was transported to our hospital's emergency department after a vehicle accident. The patient had diabetes mellitus for 10 years and she developed a hypoglicemic coma in the day of accident. The patient was quadriparetic (MRC power 4/5, Asia D) with severe neck pain. Plain radiographs, computerize tomography and spinal magnetic resonance imaging showed C6-7 spondyloptosis and C5, C6 posterior element fractures (). Gardner-Wells skeleton traction was applied with 7 kg, after radiological evaluation. The traction weight was increased gradually and achieved to total 20 kg. Spinal alignment was reachived by traction and dislocation was decreased to a grade 1 spondylolisthesis. Then the patient was initially operated by anterior approach. Anterior decompression was achieved by C6-7 discectomy. The anterior longitudinal ligament was torn and a cerebrospinal fluid (CSF) leakage was detected from a dural defect. Dural defect repaired partially by a synthetic dural substitute and fibrin sealant. Anterior stabilization was performed by C5-7 screw-plate system. The fusion was achieved by a cadaver fibula graft. A lumbar drainage system was placed after operation and CSF was drainaged continuously for 5 days. Seven days after first operation the patient was operated by a posterior approach. C5 partial, C6 total laminectomy and foraminotomy was performed. The posterior stabilization was performed C4 to T2 by C4-5 lateral mass and T1-T2 transpedicular screw fixation and constructs. Also, posterior fusion was done by autogeneous bone graft. Postoperative lateral X-rays and three-dimensional computed tomography showed the physiological realignment and the correct screw placements (, ). The postoperative period was uneventful without any additional complication. The post-operative hospitalization time was 7 days. The patient was discharged from the hospital with a rigid cervical orthosis. The patient's quadriparesis was improved significantly. Lower-extremity paresis was completely resolved only distal part of the upper-extremity : finger flexion, finger extension and opposition were slightly paretic. The patient was neurologically intact at the second month of the follow-up after a rehabilitation (Asia E).