Traumatic coronal spondyloptosis of the spine: case report and review of the literature.

Background: Traumatic coronal spondyloptosis (TCS) describes complete coronal subluxation of a vertebral body relative to an adjacent segment secondary to high-energy trauma. TCS commonly associates with orthopedic, intraabdominal, and thoracic solid organ injury, nuancing overall management. Surgery is indicated for subluxation reduction, deformity correction, and stabilization. Thoracolumbar junctional TCS has a sparse description in the literature. As a complex deformity encounterable by spinal surgeons regularly managing spinal cord injury and spinal trauma, appropriate surgical management requires an understanding of the various operative approaches as well as available intraoperative technical adjuncts. We accordingly discuss our surgical technique for subluxation reduction, deformity correction, and stabilization, and review approaches employed for similar reported cases. Case Description: We describe the case of a 36-year-old female presenting to Temple University Hospital after an automotive versus pedestrian injury. She demonstrated gross traumatic spinal deformity, secondary intraabdominal injuries, and was paraplegic on initial neurologic examination. After abdominal solid organ injury management and hemodynamic stabilization, the patient underwent standard pedicle screw fixation spanning the thoracolumbar junction from T9-L4, with complete coronal spondyloptosis correction achieved via manual caudal reduction after completion of a single-level unilateral facetectomy at T12-L1. Conclusions: This complex traumatic spinal deformity underwent reduction and stabilization via techniques accessible to most spinal surgeons. Paraplegia on presentation obviated the need for intraoperative neuromonitoring and enabled muscle relaxant use to facilitate deformity correction. When requiring either neuromonitoring or a higher magnitude of distraction, we advise usage of distraction instrumentation and consideration of vertebrectomy for safe reduction. Understanding the variety of surgical options in the operative management of TCS is critical for safe and effective correction.