Posterior-Only Reduction of High-Grade Traumatic Thoracic Spondyloptosis

TL;DR

This case report presents a new surgical technique for treating severe spinal injuries using a posterior-only approach, avoiding more invasive methods.

Contribution

A novel posterior-only reduction technique using monoaxial screws and a distraction trauma system is introduced for high-grade thoracic spondyloptosis.

Findings

The technique reduced sagittal subluxation by 12 mm and coronal translation by 19 mm.

Traumatic kyphosis improved from 24.6° pre-operatively to 7.8° post-operatively.

Neurological function improved post-operatively with maintained spinal alignment.

Abstract

Traumatic thoracic spondyloptosis is a rare, severe spinal injury that poses a major surgical challenge. Traditional approaches often involve complex mechanical maneuvers and increased patient risk. This case report describes a posterior-only reduction and stabilization technique using a distraction trauma system, monoaxial screws, and neuromonitoring, offering an alternative to more invasive strategies such as corpectomy or multi-rod constructs.

A patient with traumatic lateral T6-T7 spondyloptosis underwent single-stage posterior reduction using a spine distraction trauma system. The technique employed monoaxial pedicle screws and controlled application of multi-plane forces while avoiding early exposure of neural elements during reduction, reducing intra-operative risk. The spondyloptosis was reduced to a near-anatomic position, reversing approximately 12 mm of sagittal subluxation and 19 mm of coronal translation. Traumatic kyphosis improved from 24.6° pre-operatively to 7.8° post-operatively. Post-operative imaging confirmed maintained alignment, and neurological function showed continued improvement at follow-up.

This posterior-only technique enabled effective and controlled reduction of a high-grade fracture-dislocation without requiring anterior corpectomy or complex instrumentation. Compared to existing methods, such as Cobb elevator-assisted leverage, multi-rod constructs, or corpectomy, the described approach simplifies the surgical workflow. The use of monoaxial screws and a distraction trauma system may present a safe and reproducible strategy for managing severe thoracic spondyloptosis.

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