497 A Single-Stage Three-Rod System for Sequential Reduction of Thoracic Spondyloptosis: A Technical Note and Literature Review

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INTRODUCTION: Spondyloptosis is a rare yet severe spinal deformity defined as more than 100% subluxation of adjacent vertebral bodies. Timely reduction and stabilization are important to promote rehabilitation and improve quality of life. METHODS: A 32-year-old male sustained a sagittal T9/10 spondyloptosis in a bicycle accident. to reduce the dislocation, we employed a single-stage posterior approach and a three-rod construct. One continuous rod was secured caudal to the fracture, and two temporary short rods were placed contralaterally with one rostral and one caudal to the fracture. Two rod holders were placed on the short rods flanking the injury site, and a distractor was used to sequentially distract against the rod holders to achieve satisfactory reduction. This approach was performed with minimal osteotomy, and reduction was accomplished in less than 20 minutes after initial exposure. We also conducted a literature review on the characteristics and surgical management of thoracic spondyloptosis. RESULTS: Postoperative imaging showed stable, near-complete reduction (Grade V to Grade I). Patient was discharged on postoperative day 9. At four-month follow-up, he regained voluntary toe movement and sphincter reflex and had improved trunk control. Literature review identified 25 case reports/series and 42 patients. Most injuries occur at mid-to-lower thoracic levels in the sagittal plane caused by high-energy trauma. Over 50% of patients required substantial bony resection during distraction and reduction. Three (7.14%) patients who were neurologically intact underwent posterior in situ fixation without reduction. CONCLUSIONS: We described a single-stage posterior approach using a three-rod system to reduce spondyloptosis with minimal osteotomy. This technique strikes a balance between efficiency and precision, making it particularly advantageous in a trauma setting.

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