Summary of "Posterior listhesis of a lumbar vertebra in spinal tuberculosis." The management of spinal tuberculosis, especially in children, is controversial.
Atlantoaxial instability with and without basilar invagination poses a considerable challenge in management regarding reduction, surgical approach, decompression, instrumentation choice, and extent of fusion. A variety of strategies have been described to reduce and stabilize cranial settling with basilar invagination. Modern instrumentation options included extension to the occiput, C1–C2 transarticular fixation, and C1 lateral mass–C2 pars among others. Since not all cases of cranial settling are the same, their treatment strategies also differ. Factors such as local vascular anatomy, amount of subluxation, need for distraction, and shape of occipital condyles will dictate level and type of instrumentation. The objective of this study was to outline treatment options and provide a rationale for the surgical plan.
lateral listhesis (rotatory subluxation ...
A 14-year-old male patient with Down syndrome who presented with a 4-week history of left upper extremity weakness and torticollis. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a significant rotatory subluxation with associated spinal cord compression ( and ). The patient underwent a trail of preoperative traction which did not result in deformity reduction. He was taken to the operating room where he underwent open instrumented reduction and fusion from occiput to C2.
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This lateral c-spine fracture shows a compression fracture of C6 with an anterior-inferior vertebral body fragment. There is widening of the interspinous distance (seen well on the AP view, click image to see). Note loss of vertebral body height on both AP and lateral views.
Also known as flexion/extension fracture, the findings are: compression fracture of a (usually lower) cervical vertebra, with anterior-inferior corner separation (the “teardrop”); widening of the interspinous distance at the same level or the level above; and widening or mild rotatory subluxation of facet joints. There may be slight associated listhesis. CT scan is indicated for further assessment of these fractures, as there are often other fractures not seen on plain film. Teardrop fractures are universally unstable, with disruption of anterior, middle and posterior columns. There is a high incidence of associated cord injury, which is best assessed with MRI, including a gradient-echo sequence for cord haematoma.
Reference: Brant-Zawadzki M, et al. Spine: Top 100 Diagnoses Amirsys 2002
Credit: Dr Laughlin Dawes
Degenerative Spondylolisthesis - Spine - …
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