Elsevier

World Neurosurgery

Volume 110, February 2018, Pages 129-132
World Neurosurgery

Case Report
Spontaneous Fusion of S2/S3 Spondyloptosis in an Adult

https://doi.org/10.1016/j.wneu.2017.10.001Get rights and content

Background

Spondyloptosis is grade V on the Meyerding classification. Traumatic spondyloptosis can occur throughout the spinal column, particularly at junctional levels, and finding an ideal surgical strategy to address it remains a challenge for spinal surgeons. The sacrum is considered a united bone in adults, and sacral intersegmental spondyloptosis is extremely rare.

Case Report

Herein, we present an unusual case of S2/S3 spondyloptosis in a 27-year-old female patient with spontaneous solid fusion.

Conclusions

This case demonstrates that similar distal sacral pathologies may be managed conservatively when there is no associated neurologic deficit, and the osteodiskoligamentous integrity of the lumbosacropelvic unit remains intact. Our report plus the very few published papers in the literature illustrate the natural history of uncomplicated traumatic spondyloptosis and support the role of in situ fusion and instrumentation as a reliable alternative to circumferential fusion in patients who cannot tolerate staged or prolonged operations.

Introduction

Spondyloptosis is defined as grade V on the Meyerding classification1 with complete loss of sagittal correlation between 2 adjacent vertebrae. High-impact injury with abrupt disruption of posterior ligament-osseous structures is the main mechanism in traumatic cases, whereas gradual progression of slippage in high-grade spondylolisthesis is the underlying mechanism in nontraumatic cases.

Overt spinal instability, pain, and neurologic compromise are the main concerns in traumatic patients and make immediate fusion inevitable in most cases. This entails neural decompression and simultaneous fusion (in situ, posterior, anterior, or combined anterior and posterior).

Because most cases are treated surgically, little is known about the natural history of traumatic spondyloptosis. Here, we present an unusual case of traumatic S2/S3 spondyloptosis in an adult patient with spontaneous fusion and discuss the relevant literature.

Section snippets

History and Examination

A 27-year-old athletic female patient presented with intermittent mechanical low back pain without radiculopathy. The pain was more severe while standing; however, she could undertake her usual daily activities, as well as aerobics. The patient reported that the pain had not increased in severity during the previous 3 months; however, she had taken to the use of nonsteroidal antiinflammatory drugs for analgesia. There was no associated leg weakness or loss of sphincter function according to the

Discussion

Sacral injuries typically present with concurrent pelvic fractures in polytrauma patients, yet many such injuries may be missed during the initial imaging work-up in the emergency department, should a high index of suspicion not be maintained.2 Sacral fractures can easily be overlooked on simple spine radiographs. When an anterior or posterior pelvic fracture is present on anteroposterior radiography, a low diagnostic threshold should be set for associated sacral fractures, which could easily

Conclusion

Traumatic sacral spondyloptosis is a rarity in adults, but it can occur before the ultimate fusion of sacral segments (25–33 years of age). When the sacroiliac joints are intact and there is no associated neurologic deficit, conservative treatment with bed rest and bracing can lead to spontaneous solid fusion.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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