Posterior Realignment and Anterior Column Reconstruction of Thoracic Spondyloptosis Using Intraoperative CT and Navigation: Case Report and Review of the Literature.
- 1Department of Neurosurgery Neurocenter of South Switzerland, EOC, Lugano, Switzerland.
- 2Neurosurgical Outcomes Research & Analytics (NORA) Laboratory, Lugano, Switzerland.
Abstract
Traumatic thoracic spondyloptosis is an exceptionally unstable three-column injury, usually caused by high-energy trauma and frequently associated with severe spinal cord injury. Reduction and reconstruction are technically demanding because normal anatomical relationships are lost. An 18-year-old man presented after a motorcycle collision with complete paraplegia and a T4 sensory level, consistent with AIS A spinal cord injury. CT demonstrated T5-T6 spondyloptosis with translation, rotation, vertebral comminution, and complete spinal-column disruption; MRI showed severe cord distortion, T2 hyperintensity, and an epidural hematoma. Emergency single-stage posterior surgery included CT-based neuronavigated pedicle screw placement, T6 laminectomy and corpectomy, T5 decompression, epidural hematoma evacuation, progressive realignment, and anterior-column reconstruction with an interbody cage. Repeated intraoperative CT acquisitions were used to reassess the changing anatomy and verify instrumentation, cage position, and final alignment. Postoperative imaging confirmed satisfactory reconstruction. No perioperative complication occurred. At 5-year follow-up, neurological status remained unchanged. In selected patients with severe mid-thoracic spondyloptosis, a posterior-only strategy can permit decompression, realignment, anterior-column reconstruction, and definitive stabilization in one procedure. Iterative intraoperative CT-based navigation may be particularly useful when anatomy changes substantially during reconstruction, although comparative data are lacking.
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BibTeX
@article{zaed2026posterior,
title = {{Posterior Realignment and Anterior Column Reconstruction of Thoracic Spondyloptosis Using Intraoperative CT and Navigation: Case Report and Review of the Literature.}},
author = {Ismail Zaed and Dominique E Kuhlen and Francesco Marchi},
journal = {International medical case reports journal},
year = {2026},
month = oct,
doi = {10.2147/imcrj.s653615},
url = {https://europepmc.org/article/MED/42953787},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Posterior Realignment and Anterior Column Reconstruction of Thoracic Spondyloptosis Using Intraoperative CT and Navigation: Case Report and Review of the Literature.
AU - Ismail Zaed
AU - Dominique E Kuhlen
AU - Francesco Marchi
PY - 2026
DA - 2026/10/24
JO - International medical case reports journal
DO - 10.2147/imcrj.s653615
UR - https://europepmc.org/article/MED/42953787
AB - Traumatic thoracic spondyloptosis is an exceptionally unstable three-column injury, usually caused by high-energy trauma and frequently associated with severe spinal cord injury. Reduction and reconstruction are technically demanding because normal anatomical relationships are lost. An 18-year-old man presented after a motorcycle collision with complete paraplegia and a T4 sensory level, consistent with AIS A spinal cord injury. CT demonstrated T5-T6 spondyloptosis with translation, rotation, vertebral comminution, and complete spinal-column disruption; MRI showed severe cord distortion, T2 hyperintensity, and an epidural hematoma. Emergency single-stage posterior surgery included CT-based neuronavigated pedicle screw placement, T6 laminectomy and corpectomy, T5 decompression, epidural hematoma evacuation, progressive realignment, and anterior-column reconstruction with an interbody cage. Repeated intraoperative CT acquisitions were used to reassess the changing anatomy and verify instrumentation, cage position, and final alignment. Postoperative imaging confirmed satisfactory reconstruction. No perioperative complication occurred. At 5-year follow-up, neurological status remained unchanged. In selected patients with severe mid-thoracic spondyloptosis, a posterior-only strategy can permit decompression, realignment, anterior-column reconstruction, and definitive stabilization in one procedure. Iterative intraoperative CT-based navigation may be particularly useful when anatomy changes substantially during reconstruction, although comparative data are lacking.
SN - 1179-142X
ER -