Systematic Review of Traumatic Thoracic Spondyloptosis and Presentation of a Novel Approach for Management With Quad Rod Construct

BACKGROUND: Traumatic thoracic spondyloptosis (TTS) is a rare but devastating spinal injury often secondary to high-impact trauma. TTS is typically managed with surgical fusion and stabilization. OBJECTIVE: To evaluate current surgical management of TTS while presenting a novel surgical technique for reduction and fusion. METHODS: We performed a systematic review of surgical management of TTS using Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data guidelines with 2 independent reviewers. We identified patient demographics, level of spondyloptosis, American Spinal Injury Association grade, level of spinal fusion, surgical approach, type of construct used, and reduction of fracture. RESULTS: Seventeen articles with 37 patients with TTS managed surgically were identified. The male:female ratio was 31:6. The average age was 33 years (+/- 15). Motorized injury including motor vehicle accident, road traffic accident, and motor vehicle collision (16 patients, 43%) and fall including fall from height, stairs, train, or standing (16 patients, 43%) were equivalent. The middle (15 patients 40%) and lower (18 patients, 49%) thoracic regions were similar for the level of spondyloptosis. Thirty-four patients (92%) were American Spinal Injury Association A. Thirty-six patients (97.3%) underwent posterior only surgery and 1 (2.7%) underwent a combined posterior-anterior approach. There were 29 (78%) dual rod constructs and 8 (22%) dual rod with connectors or crosslinks. Complete reduction was obtained in 24 (65%) patients, incomplete in 11 (30%), and 2 (5%) patients were not reported. Two of our patients underwent novel quad rod reconstruction with complete reduction. CONCLUSION: Surgical management of TTS is typically posterior only with complete fracture reduction. We have presented a novel quad rod approach for reduction of TTS.