Leveron&Nexovas
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 11671  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (1,151 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 » Methods
 » Results
 » Discussion
 » Conclusions
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    Viewed260    
    Printed20    
    Emailed0    
    PDF Downloaded10    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
ORIGINAL ARTICLE
Year : 2022  |  Volume : 70  |  Issue : 8  |  Page : 182-188

Management of Pediatric and Adolescent Traumatic Thoracolumbar Spondyloptosis


1 Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Date of Submission08-Jun-2019
Date of Decision10-Oct-2019
Date of Acceptance21-Jan-2020
Date of Web Publication11-Nov-2022

Correspondence Address:
Pankaj Kumar Singh
Department of Neurosurgery, Room No. 717, Neurosciences Center, All India Institute of Medical Sciences, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.360921

Rights and Permissions

 » Abstract 


Background: Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by high-energy trauma. Pediatric patients with a traumatic spine injury, particularly spondyloptosis are surgically demanding as reduction and achieving realignment of the spinal column requires diligent planning and execution.
Objective: To enlighten readers about this rare but severest form of thoracolumbar spine injury and its management.
Methods: Retrospective analysis of patients treated here with spondyloptosis between 2008 and 2016 was done.
Results: Seven children, ranging from 9 to 18 years (mean years) age were included in the study. Five patients had spondyloptosis at thoracolumbar junction and one each in the lumbar and thoracic spine. All patients underwent single-stage posterior surgical reduction and fixation except one patient who refused surgery. Intraoperatively, cord transection was seen in five patients while dura was intact in one patient. The mean follow-up period was 17 months (1–36 months) during which one patient expired due to complications arising from bedsores. All patients remained American Spinal Injury Association (ASIA) A neurologically.
Conclusions: Traumatic spondyloptosis is a challenging proposition to treat and the aim of surgery is to stabilize the spine. Rehabilitation remains the most crucial but the neglected part and dearth of proper rehabilitation centers inflict high mortality and morbidity in developing countries.


Keywords: Adolescent, pediatric, rehabilitation spondyloptosis, surgical reduction and fixation, thoracolumbar spine trauma
Key Message: This is the first series to date on pediatric and adolescent traumatic thoracolumbar spondyloptosis. Fixation of the spine, although has a dismal neurological outcome, does help in the early postoperative rehabilitation, which remains the most crucial but neglected segment of managing such cases. The dearth of rehabilitation centers inflicts high mortality and morbidity rates in developing countries.


How to cite this article:
Garg M, Kumar A, Sawarkar DP, Agrawal M, Singh PK, Doddamani R, Agrawal D, Gupta D, Satyarthee G, Chandra P S, Kale SS. Management of Pediatric and Adolescent Traumatic Thoracolumbar Spondyloptosis. Neurol India 2022;70, Suppl S2:182-8

How to cite this URL:
Garg M, Kumar A, Sawarkar DP, Agrawal M, Singh PK, Doddamani R, Agrawal D, Gupta D, Satyarthee G, Chandra P S, Kale SS. Management of Pediatric and Adolescent Traumatic Thoracolumbar Spondyloptosis. Neurol India [serial online] 2022 [cited 2022 Dec 3];70, Suppl S2:182-8. Available from: https://www.neurologyindia.com/text.asp?2022/70/8/182/360921




Spinal injuries are relatively uncommon in the pediatric age group accounting for 2.7 to 9% of all spine injuries.[1],[2],[3],[4] Cervical spine injuries constitute 40–60% of injuries[1],[4],[5] while the majority of pediatric thoracolumbar spine trauma occurs in children above 14 years of age.[6]

Thoracolumbar injuries in children usually present with endplate fractures with superior endplate being more common.[7],[45] The pediatric spine is more elastic than adults[8] owing to the shallow facet joints[9] and stretchable ligaments and joint capsules.[10],[44] Thus, trauma to the spine would commonly produce neurological deficits rather than fracture-dislocations. It would require an enormous high-velocity injury to cause three-column injury and subluxation of vertebral bodies thus making spondylolisthesis a rare phenomenon in children with only sporadic case reports of pediatric traumatic spondyloptosis.[11],[12],[13]

Complete fracture-dislocation and greater than 100% subluxation of adjacent vertebral bodies in the coronal or sagittal plane is defined as grade V spondylolisthesis or spondyloptosis.[13],[14],[15],[17] The upper vertebral body may be displaced anteriorly, laterally, or posteriorly to the caudal vertebra resulting in sagittal/coronal plane spondyloptosis.[11],[12],[13],[14],[46] According to Denis classification,[18] spondyloptosis is a fracture-dislocation type of injury with the severance of all three columns of the spine. Vaccaro's thoracolumbar injury classification and severity (TLICS) system[19] acknowledges it as the most severe and unstable form of spine injury.

Spinal spondyloptosis often results in complete cord injury, especially in the thoracic spine, where there is the dearth of space around the neural elements.[16],[17],[20] Spondyloptosis in children present unique surgical challenges as reduction and spinal column realignment requires precise planning and execution.[47],[48]

In this series, we describe the clinical history and radiological characteristics of seven pediatric and adolescent cases of traumatic spondyloptosis involving the thoracolumbar vertebrae, their surgical management and outcomes in a health care setting wherein specialized rehabilitation centers are lacking.


 » Methods Top


Retrospective data analysis over the last 9 years (2008–2016) was done from the departmental database at our center. Records of all patients, aged 18 years or less, with thoracolumbar injuries having a diagnosis of “listhesis” were retrieved to figure out cases of spondyloptosis. As this was a retrospective analysis of the data of patients operated using standard surgical techniques and no new treatment algorithm or procedure was proposed, ethical clearance was not sought. Spondyloptosis was described on computed tomography (CT)/magnetic resonance (MR) scans as complete subluxation (>100%) of the adjacent vertebra. On axial CT slice, it was described as a “double vertebral sign.”[14]

All patients aged 18 years or less whose spinal deformity was in agreement with the criterion of spondyloptosis were incorporated in the study. The clinical records and radiological data were evaluated to determine the neurological status and severity of injury in terms of the American Spinal Injury Association (ASIA) grading and TLICS scale, respectively.

The surgical vs conservative management plan was decided by the treating neurosurgeon. All patients had clinical and radiological follow-up via outdoor appointments.


 » Results Top


A total of six boys and one girl, ranging in age from 9 to 18 years (mean 15.1 years), were included in the study. The girl sustained an injury due to wall collapse over her back. Two boys were involved in high-velocity road traffic accidents while two presented with fall from height. One patient was run over by a tractor while another patient suffered dorsal spine injury when he fell in a mortar mixing machine [Table 1].
Table 1: Data Summary of seven patients of spondyloptosis

Click here to view


One patient sustained chest injury resulting in multiple rib fractures and hemothorax. All seven patients had spondyloptosis >100% subluxation of adjacent vertebra. All patients underwent CT or MR imaging or both. Five patients had an injury at the thoracolumbar junction, that is, from T-11 to L-2 while one each at lumbar and dorsal spine. The TLICS score for all the patients was 8 (3 each for fracture morphology and posterior ligamentous complex and 2 for neurological deficit). Neurologically, each patient presented with ASIA A grade.

Six patients underwent single-stage posterior surgical reduction and fixation while one patient opted against surgery when prognosticated regarding the injury and chances of neurological improvement. The mean interval between the time of injury and surgery was 13.5 days (3–29 days). The number of levels of fixation was the surgeon's personal decision which varied from two to three levels above and below the fracture level.

Intraoperatively, cord transection was seen in five patients while one patient had a severely compressed cord. In cases of cord transection, the proximal end was ligated with purse-string suture and reinforced with fibrin glue. Complete reduction and alignment with the restoration of the height of the spine could be achieved in four patients, out of whom two patients underwent corpectomy of an irreducible posteriorly displaced vertebral body with mesh cage placement. In the remaining two cases, the spinal height was reduced by one vertebra as the impacted adjacent vertebra could not be aligned and the spine fixation was done minus the irreducible corpectomy vertebral body.

The mean postoperative stay was 14.3 days (4–48 days) with the longest stay of 48 days required by the patient with associated lung injury for which he had to be tracheostomized and ventilated for a prolonged duration. No incidence of decubitus ulcer or deep vein thrombosis was noticed during the hospital stay. All patients were educated about home-based rehabilitation before discharge. The mean follow-up period was 17 months (1–36 months). In the course of follow-up, one patient expired 2½ years post-surgery due to complications arising from bedsores. All patients remained neurologically the same, that is, ASIA A during the follow-up. There was no evidence of pseudoarthrosis or implant failure during follow-up.

Illustrative case 1 [[Table 1], Case 3—Able to achieve normal spinal column alignment].

A 15-year-old male presented with a history of injury sustained while working at a construction site wherein he fell in a mortar mixing machine. On arrival, the patient was paraplegic with power 0/5 at all joints of bilateral lower limbs and loss of bladder and bowel sensations. Thus, he suffered from ASIA grade A spinal cord injury (SCI). Thoracolumbar CT scanning showed spondyloptosis at the T12-L1 level with a complete displacement of the L1 vertebral body with respect to T12. [Figure 1] There were no other associated injuries.
Figure 1: (a) Sagittal image of a CT scan showing T12-L1 spondyloptosis. (b) Axial CT image showing the “double vertebrae sign” as a result of posteriorly displaced L-1 vertebral body with respect to T12

Click here to view


Surgery: The patient underwent a single-stage posterior spinal stabilization procedure 5 days after admission. On exposure, the L1 vertebral body was seen impacted posterior to the T12. The thecal sac was lacerated and the cord was completely transected. Pedicle screws were placed bilaterally from T10 to L3.

The displaced T12 and L1 vertebral bodies could not be reduced with distraction. No further maneuvers were attempted to avoid any collateral damage to the adjacent structures. Therefore, L1 vertebrectomy was done to reduce and align the L2 vertebra under the T12 vertebral body. The autograft bone fragments from corpectomy L1 vertebra were placed over the decorticated posterolateral surfaces of instrumented vertebrae and space between T12 and L2 to achieve bony fusion. The thecal sac was identified and the purse-string suture was applied at both ends with 4-0 prolene ensuring watertight closure to avoid any cerebrospinal fluid (CSF) leak which was confirmed intraoperatively by Valsalva maneuver. The closed ends were covered with fat and reinforced with fibrin glue. The final construct consisted of 10 pedicle screws with contoured rod fixation spanning from T10 to L3 minus the L1 vertebra thus reducing the total spinal column height. The autograft bone fragments harvested from corpectomy of the L1 vertebra were placed between the T12 and L2 vertebral bodies and over the decorticated posterolateral surfaces of instrumented vertebrae to achieve bony fusion [Figure 2]a and [Figure 2]b.
Figure 2: (a) Postoperative sagittal image. (b) Coronal 3D CT image showing a good reduction of the spondyloptosis. L1 corpectomy done and autograft bone pieces placed in the space between T12 and L1. (c) Sagittal CT image at 9 months follow-up showing good alignment with evidence of fusion between T12 and L2 vertebral bodies

Click here to view


Postoperative Course: The patient had an uneventful postoperative recovery. He was discharged on the 9th postoperative day for home-based rehabilitation. At 9 months follow-up, the patient remained neurologically the same and ambulatory in a wheelchair. A follow-up CT scan showed good alignment of the spine with evidence of bony fusion [Figure 2]c.

Illustrative case 2 [[Table 1], Case 4—Not able to achieve normal spinal column alignment].

An 18-year-old male presented to us with a road traffic accident, when the vehicle he was traveling in collided with an animal. Neurologically, he had ASIA grade A SCI. Imaging showed a L1-L2 lateraloptosis. [Figure 3]a, [Figure 3]b, [Figure 3]c There were no other associated injuries.
Figure 3: (a) 3D reconstructed image shows L1-L2 rotatory lateraloptosis. (b) Axial CT image showing the “double vertebrae sign”. (c) Sagittal T2W MRI image shows evidence of cord transection. Postoperative reconstructed. (d) sagittal and (e) coronal images show the reconstructed spine using screw rods with partial reduction of L1 over L3 and L2 partial corpectomy

Click here to view


Surgery: The patient underwent a single-stage posterior spinal stabilization procedure 7 days after admission. On exposure, there was L1-L2 rotatory spondyloptosis. The thecal sac was lacerated, there was nerve root herniation and the cord was completely transected. Pedicle screws were placed in T12, L1, L3, and L4 vertebral bodies on the left side and in T12, L1, and L4 bodies on the right side. The displaced L1 and L2 bodies could not be reduced after distraction. So, a partial corpectomy of L2 was done in order to partially reduce L1 vertebral body over L3. The thecal sac was managed similarly as above. The screws were connected using rods and bilateral posterolateral fusion was done using autograft bone chips. An interconnecting rod was placed to provide additional stability [Figure 3]d and [Figure 3]e.

Postoperative Course: The patient had an uneventful postoperative recovery. He was discharged on 5th postoperative day for home-based rehabilitation. A follow-up CT scan after 1 year showed evidence of bony fusion [Figure 4]. He had no postoperative improvement of neurological status.
Figure 4: Follow-up CT scan at 1-year shows (a) sagittal, (b) coronal, (c and d) parasagittal images with partially reduced lateraloptosis with evidence of fusion

Click here to view



 » Discussion Top


Anatomical considerations of the pediatric spine

Traumatic spinal fractures are rare in the pediatric population but the incidence increases in adolescence.[51] The adolescent spine achieves speedy skeletal maturity with rapid growth changes in anatomic, biomechanical, and radiographic properties. The majority of pediatric thoracolumbar spine fractures occur in the teenage group especially those aged between 14 and 16 years.[6] In our study, five out of seven patients (71.43%) were teenagers, which is in accordance with the literature. The pediatric spine differs from that of an adult in various aspects. The juvenile spine has horizontal and partially ossified facets thus resulting in enhanced spinal mobility. The mature configuration is achieved by 8 years of age but the adult pattern of the obliquity of joints is seen only after 15 years of age. The fusion of endplate begins at around this time and is accomplished by the age of 21–25 years.[6] Aufdermaur,[21] in his anatomic studies showed that fractures of the juvenile spine pass through the growth zone of physis, thus, having supreme healing capacity unlike a similar fracture in adults.[49]

The three main mechanisms of spinal injury in the pediatric group are flexion with or without compression, distraction, and shear with hyperflexion injuries being the most common.[6],[50] Shear injuries result in fracture-dislocations and subluxation of vertebral bodies with failure of all three columns described by Denis[18] and is often associated with SCIs.

Special features of managing pediatric and adolescent spondyloptosis

Spondyloptosis which is the severest form of spine trauma was first described as grade V spondylolisthesis or subluxation of more than 100% of L5 vertebra over sacrum by Neugebauer[22] in 1882. This term is now used for all spinal levels with more than 100% subluxation of adjacent vertebra.[13],[14],[15],[16],[17] Such injuries are caused by the shear-type mechanism of injury caused by a high-velocity force. Pediatric thoracolumbar traumatic spondyloptosis has been scantily reported in the literature[11],[12],[13] [Table 2]. Prior to the current series, only three such cases of pediatric spondyloptosis have been described in the literature.
Table 2: Literature review of cases reports of pediatric spondyloptosis

Click here to view


The present series reports seven cases of pediatric spondyloptosis with complete neurological injury. The documented incidence of complete neurological injury in adult spondyloptosis series is 80%[20],[23] while in the current series all the patients presented with a complete injury. The most common mode of injury has been described as high-speed road traffic accidents[13],[24],[25] while the present study had a variety of causes of spine injury with only two patients (28.57%) each presenting with a history of road traffic accident and fall from height. All the seven injuries were the aftermath of the impact by vectors with tremendous force. Males are more commonly affected population with a reported incidence of 60%[13] which is less than the current series which had six male subjects out of seven (85.7%).

Spinal trauma is many a time associated with other system injuries such as intra-abdominal and thoracic injuries, head injuries, and long bone fractures.[5],[26],[27],[28] The impact of an injury-causing spondyloptosis is immense, resulting in multisystem collateral damage.[13] Head injury is the most commonly associated injury[27],[28] but none of our patients suffered any head injury. One patient sustained rib fractures with hemothorax requiring chest tube drainage. The thoracic spine has been documented as the most affected region in pediatric thoracolumbar fractures followed by the lumbar and thoracolumbar junction,[25],[29] while thoracolumbar junction has been described as the most common location for spondyloptosis.[13]

Most of the pediatric spinal injuries (except spondyloptosis) can be managed conservatively contrary to adults.[26],[52] With advancements in the spinal disorders therapeutics, the treatment guideline for pediatric patients is the same as that in adults.[30] Most of the surgeons now consider surgical treatment in view of the risks associated with braces and prolonged immobilization.[31],[53] Surgery is usually indicated for neural elements decompression, grossly unstable injuries with progressive neurological deficit, nonreducible dislocations, and progressive deformities.[32],[33],[34],[35],[36],[54]

Thoracolumbar instrumentation with pedicle screws has been well-described for pediatric traumatic spine fractures.[25],[33] The healing is evident with noticeable callus formation with no complications. Long segment fixations are usually shunned for preserving the growth potential of the pediatric spine.

Various approaches such as anterior,[23] posterior,[15],[16],[37] and combined anterior-posterior[38],[39] have been reported for the management of spondyloptosis. Gressot et al.[40] in their case report on congenital spondyloptosis recommended posterior only approach for circumferential decompression and fusion in children. All patients in the current series underwent a single-stage posterior fixation of the spine. The elementary aim of surgery is a reduction with spinal realignment and stabilization[16],[20] to enable early mobilization and rehabilitation of the patient. After exposure, the pedicle screws were placed under C-arm/O-arm guidance.

Based on reducibility by distraction, spondyloptosis can be divided into reducible and irreducible cases.[41] In spondyloptosis, the adjacent vertebral bodies are almost glued to each other and the distraction force required to reduce and align them is exorbitant. Any attempt to do so may needlessly risk injury to nearby vital structures and should be avoided.[38]

Gitelman et al.,[15] in his review of 22 patients of thoracic fracture-dislocation, could not achieve complete reduction and alignment in 31.3% patients. In the current series, four cases of spondyloptosis were irreducible, hence, alignment of the vertebral column was achieved after the corpectomy of the dropped out vertebra. Out of these, the spinal column got shortened in two cases where cage could not be placed in spite of maximum possible but safe distraction whereas in two cases, the mesh cage was placed and the spinal height was restored.

The documented complication rate is 35–60%. The various complications reported are deep vein thrombosis (DVT), pneumonia, septicemia, CSF leak from the surgical wound and prolonged intubation.[13]

Highlighting the need for postoperative rehabilitation

Although the incidence of spinal injury in the pediatric age group is low as compared to adults, it is associated with a higher mortality rate with a ratio of 2.5:1 (28% vs 11%).[1] Mortality due to bedsore complications in one patient is suggestive of the inadequacy of home-based care and probably unavailability/unaffordability of proper rehabilitation facilities in developing countries.

There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury.[42],[43] As in spondyloptosis, injury is complete; it creates more problems in rehabilitation. SCI children have special needs because of their potential for physical, intellectual, psychological, and social growth.[16] It not only causes damage to independence and physical function but also leads to many complications from the injury such as neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders.[43] Moreover, the treatment and rehabilitation period is long, expensive, and exhausting in SCI as well as it requires patience and motivation of the patient and relatives.[43]

The overriding goal for comprehensive medical rehabilitation is to provide services required by the child for maximal recovery and to compensate for lost or impaired function while permitting the fullest development of potential in all areas.[42] Rehabilitation involves the child and his family, a hospital-based and rehabilitation center-based team, and a school.[42] Every effort must be made to prevent medical and/or physical complications that could interfere with rehabilitation or lead to greater disability. Family counseling and education are of paramount importance. By fostering the achievement of new adaptive skills, motivation can be maintained with consequent psychological benefit. Various factors which are needed to be taken care of are therapy training in mobility, personal care, and daily living activities; prevention and control of deformities and bedsores; bowel and bladder regulation; control of painful spasms; control of vasomotor dysfunction; prevention, control, and treatment of renal complications; maintenance of good nutrition without obesity. Also, introduction to recreational activities, return to home and chosen school, promotion of educational pursuits with training for future work and independent living options, and adaptation of housing and vehicles are important for proper rehabilitation.[42] An interdisciplinary approach is essential in rehabilitation, which includes a team led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker, and other consultant specialists as necessary.[43]


 » Conclusions Top


This is the first series to date on pediatric and adolescent traumatic thoracolumbar spondyloptosis. The aim of surgery should be stabilization of the spine without further collateral damage to other vital structures. Patient and their families should be counseled regarding the dismal prognosis and adequately sensitized to the need for rehabilitation, which remains the most crucial but neglected segment. The dearth of rehabilitation centers inflicts high mortality and morbidity rates in developing countries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Hamilton MG, Myles ST. Pediatric spinal injury: Review of 174 hospital admissions. J Neurosurg 1992;77:700-4.  Back to cited text no. 1
    
2.
Osenbach RK, Menezes AH. Pediatric spinal cord and vertebral column injury. Neurosurgery 1992;30:385-90.  Back to cited text no. 2
    
3.
Ruge JR, Sinson GP, McLone DG, Cerullo LJ. Pediatric spinal injury: The very young. J Neurosurg 1988;68:25-30.  Back to cited text no. 3
    
4.
Satyarthee GD, Sangani M, Sinha S, Agrawal D. Management and outcome analysis of pediatric unstable thoracolumbar spine injury: Large surgical series with literature review. J Pediatr Neurosci 2017;12:209-14.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Hadley MN, Zabramski JM, Browner CM, Rekate H, Sonntag VK. Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 1988;68:18-24.  Back to cited text no. 5
    
6.
Clark P, Letts M. Trauma to the thoracic and lumbar spine in the adolescent. Can J Surg 2001;44:337-45.  Back to cited text no. 6
    
7.
Basu S. Spinal injuries in children. Front Neurol 2012;3:96.  Back to cited text no. 7
    
8.
Herkowitz HN, Rothman RH. Subacute instability of the cervical spine. Spine (Phila Pa 1976) 1984;9:348-57.  Back to cited text no. 8
    
9.
Cattell HS, Filtzer DL. Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 1965;47:1295-309.  Back to cited text no. 9
    
10.
Fesmire FM, Luten RC. The pediatric cervical spine: Developmental anatomy and clinical aspects. J Emerg Med 1989;7:133-42.  Back to cited text no. 10
    
11.
Cherian I, Dhawan V. Lateral lumbar spondyloptosis. Int J Emerg Med 2009;2:55-6.  Back to cited text no. 11
    
12.
Wilkinson JS, Riesberry MA, Mann SA, Fourney DR. Traumatic lateral expulsion of the L-4 vertebral body from the spinal column. J Neurosurg Spine 2011;14:508-12.  Back to cited text no. 12
    
13.
Yadla S, Lebude B, Tender GC, Sharan AD, Harrop JS, Hilibrand AS, et al. Traumatic spondyloptosis of the thoracolumbar spine. J Neurosurg Spine 2008;9:145-51.  Back to cited text no. 13
    
14.
Bellew MP, Bartholomew BJ. Dramatic neurological recovery with delayed correction of traumatic lumbar spondyloptosis. Case report and review of the literature. J Neurosurg Spine 2007;6:606-10.  Back to cited text no. 14
    
15.
Gitelman A, Most MJ, Stephen M. Traumatic thoracic spondyloptosis without neurologic deficit, and treatment with in situ fusion. Am J Orthop (Belle Mead NJ) 2009;38:E162-5.  Back to cited text no. 15
    
16.
Lee CW, Hwang SC, Im SB, Kim BT, Shin WH. Traumatic thoracic spondyloptosis: A case report. J Korean Neurosurg Soc 2004;35:622-4.  Back to cited text no. 16
    
17.
Sekhon LH, Sears W, Lynch JJ. Surgical management of traumatic thoracic spondyloptosis: Review of 2 cases. J Clin Neurosci 2007;14:770-5.  Back to cited text no. 17
    
18.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-31.  Back to cited text no. 18
    
19.
Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: The importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005;30:2325-33.  Back to cited text no. 19
    
20.
Bohlman HH, Freehafer A, Dejak J. The results of treatment of acute injuries of the upper thoracic spine with paralysis. J Bone Joint Surg Am 1985;67:360-9.  Back to cited text no. 20
    
21.
Aufdermaur M. Spinal injuries in juveniles. Necropsy findings in twelve cases. J Bone Joint Surg Br 1974;56B: 513-9.  Back to cited text no. 21
    
22.
Neugebauer FL. Aetiologie der sogenannten spondylolisthesis. Arch Gynaekol 1882;20:133-84.  Back to cited text no. 22
    
23.
Shapiro S, Abel T, Rodgers RB. Traumatic thoracic spinal fracture dislocation with minimal or no cord injury. Report of four cases and review of the literature. J Neurosurg 2002;96 (3 Suppl):333-7.  Back to cited text no. 23
    
24.
Carreon LY, Glassman SD, Campbell MJ. Pediatric spine fractures: A review of 137 hospital admissions. J Spinal Disord Tech 2004;17:477-82.  Back to cited text no. 24
    
25.
Dogan S, Safavi-Abbasi S, Theodore N, Chang SW, Horn EM, Mariwalla NR, et al. Thoracolumbar and sacral spinal injuries in children and adolescents: A review of 89 cases. J Neurosurg 2007;106 (6 Suppl):426-33.  Back to cited text no. 25
    
26.
Birney TJ, Hanley EN. Traumatic cervical spine injuries in childhood and adolescence. Spine (Phila Pa 1976) 1889;14:1277-82.  Back to cited text no. 26
    
27.
Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg 2004;39:607-12.  Back to cited text no. 27
    
28.
Michael DB, Guyot DR, Darmody WR. Coincidence of head and cervical spine injury. J Neurotrauma 1989;6:177-89.  Back to cited text no. 28
    
29.
Reddy SP, Junewick JJ, Backstrom JW. Distribution of spinal fractures in children: Does age, mechanism of injury, or gender play a significant role? Pediatr Radiol 2003;33:776-81.  Back to cited text no. 29
    
30.
Schnee CL, Ansell LV. Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit. J Neurosurg 1997;86:48-55.  Back to cited text no. 30
    
31.
Bilston LE, Brown J. Pediatric spinal injury type and severity are age and mechanism dependent. Spine (Phila Pa 1976) 2007;32:2339-47.  Back to cited text no. 31
    
32.
Domenicucci M, Preite R, Ramieri A, Ciappetta P, Delfini R, Romanini L. Thoracolumbar fractures without neurosurgical involvement: Surgical or conservative treatment? J Neurosurg Sci 1996;40:1-10.  Back to cited text no. 32
    
33.
Santiago R, Guenther E, Carroll K, Junkins EP. The clinical presentation of pediatric thoracolumbar fractures. J Trauma 2006;60:187-92.  Back to cited text no. 33
    
34.
Shetty AP, Aiyer SN. Pediatric thoracolumbar spinal injuries: A rare and unique clinical scenario. Neurol India 2017;65:482-4.  Back to cited text no. 34
[PUBMED]  [Full text]  
35.
Acharya S. Pediatric thoracolumbar fractures: Salient points in management. Neurol India 2017;65:480-1.  Back to cited text no. 35
[PUBMED]  [Full text]  
36.
Tripathi M, Rao KN, Vazhayil V, Srinivas D, Sampath S. Rotational translational injury at the thoracolumbar junction. Neurol India 2016;64:1369-71.  Back to cited text no. 36
[PUBMED]  [Full text]  
37.
Sandquist L, Paris A, Fahim DK. Definitive single-stage posterior surgical correction of complete traumatic spondyloptosis at the thoracolumbar junction. J Neurosurg Spine 2015;22:653-7.  Back to cited text no. 37
    
38.
Yang SC, Yu SW, Chen YJ, Chen WJ. Surgical treatment for thoracic spine fracture dislocation without neurological deficit. J Formos Med Assoc 2003;102:581-5.  Back to cited text no. 38
    
39.
Weber SC, Sutherland GH. An unusual rotational fracture-dislocation of the thoracic spine without neurologic sequelae internally fixed with a combined anterior and posterior approach. J Trauma 1986;26:474-9.  Back to cited text no. 39
    
40.
Gressot LV, Mata JA, Luerssen TG, Jea A. Surgical treatment of congenital thoracolumbar spondyloptosis in a 2-year-old child with vertebral column resection and posterior-only circumferential reconstruction of the spine column: Case report. J Neurosurg Pediatr 2015;15:207-13.  Back to cited text no. 40
    
41.
Rahimizadeh A, Rahimizadeh A. Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: Case report. J Neurosurg Spine 2015;23:715-20.  Back to cited text no. 41
    
42.
Flett PJ. The rehabilitation of children with spinal cord injury. J Paediatr Child Health 1992;28:141-6.  Back to cited text no. 42
    
43.
Nas K. Rehabilitation of spinal cord injuries. World J Orthop 2015;6:8-16.  Back to cited text no. 43
    
44.
Ravikanth R. Magnetic Resonance Evaluation of Lumbar Disc Degenerative Disease as an Implication of Low Back Pain: A Prospective Analysis. Neurol India 2020;68:1378-1384.  Back to cited text no. 44
    
45.
Kandregula S, Guthikonda B. Minimally Invasive TLIF. Neurol India 2021;69:1141.  Back to cited text no. 45
[PUBMED]  [Full text]  
46.
Garg M, Kumar A, Singh PK, et al. Transpedicular Approach for Corpectomy and Circumferential Arthrodesis in Traumatic Lumbar Vertebral Body Burst Fractures: A Retrospective Analysis of Outcome in 35 Patients. Neurol India 2021;69:399-405.  Back to cited text no. 46
[PUBMED]  [Full text]  
47.
Yerramneni VK, Kanala RR, Kolpakawar S, Yerragunta T. MITLIF Operative Nuances- Step by Step. Neurol India 2021;69:1196-1199.  Back to cited text no. 47
[PUBMED]  [Full text]  
48.
Sencan S, Celenlioglu AE, Yazici G, Gunduz OH. Transforaminal Epidural Steroid Injection Improves Neuropathic Pain in Lumbar Radiculopathy: A Prospective, Clinical Study. Neurol India 2021;69:910-915.  Back to cited text no. 48
[PUBMED]  [Full text]  
49.
Goyal N, Ahuja K, Yadav G, Gupta T, Ifthekar S, Kandwal P. PEEK vs Titanium Cage for Anterior Column Reconstruction in Active Spinal Tuberculosis: A Comparative Study. Neurol India 2021;69:966-972.  Back to cited text no. 49
[PUBMED]  [Full text]  
50.
Singh V, Rustagi T, Mahajan R, Priyadarshini M, Das K. Ligamentum Flavum Cyst: Rare Presentation Report and Literature Review. Neurol India 2020;68:1207-1210.  Back to cited text no. 50
[PUBMED]  [Full text]  
51.
Amitkumar M, Singh PK, Singh KJ, et al. Surgical Outcome in Spinal Operation in Patients Aged 70 Years and Above. Neurol India 2020;68:45-51.  Back to cited text no. 51
[PUBMED]  [Full text]  
52.
Grasso G, Paolini S, Sallì M, Torregrossa F. Lumbar Spinal Fixation Removal by a Minimal Invasive Microscope-Assisted Technique. Case Report with Technical Description. Neurol India 2020;68:1211-1213.  Back to cited text no. 52
[PUBMED]  [Full text]  
53.
Kim HS, Wu PH, Raorane HD, Jang IT. Generation Change of Practice in Spinal Surgery: Can Endoscopic Spine Surgery Expand its Indications to Fill in the Role of Conventional Open Spine Surgery in Most of Degenerative Spinal Diseases and Disc Herniations: A Study of 616 Spinal Cases 3 Years. Neurol India 2020;68:1157-1165.  Back to cited text no. 53
[PUBMED]  [Full text]  
54.
Abrar WA, Sarmast A, Sarabjit Singh AR, Khursheed N, Ali Z. Aneurysmal Bone Cysts of Spine: An Enigmatic Entity. Neurol India 2020;68:843-849.  Back to cited text no. 54
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow