Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal

Abstract

Introduction: Traumatic spinal spondyloptosis, though rare, harbingers a high risk of mortality as well as permanent and disabling neurological deficits. They invariably become socially aloof and marginalized in most parts of our subcontinent owing to the lack of dedicated rehabilitation units amid their poor economic status. There is a paucity of studies pertaining to such rare epiphenomenon within our region. Materials and Methods: A study of 16 patients presenting with spinal spondyloptosis from January 2017 to January 2023 in a tertiary care center in Nepal was undertaken. The clinical records of the patients were retrieved from the hospital record section to study the demographic variables, modes of injury, American Spinal Injury Association (ASIA) grades, salient radiological characteristics, management strategies, and the resultant clinical outcomes. Result: The mean age of the cohorts in our study was 40 years with an age range of 25-80 years. Most of the patients presented in ASIA ‘A’ neurological grade (75%). The cervical spine was involved in the majority (68.75%) of cases. 8 (50%) patients left against medical advice, 2 (12.5%) were managed conservatively, and 6 (37.5%) were operated. The posterior-only approach was undertaken in 4(66.67%) cases. Tracheo-oesophageal fistula occurred in 2 (33.33%) patients. And cerebrospinal fluid (CSF) leak occurred in 2 (33.33%) patients. The overall hospital mortality was 3(37.5%). All the surviving patients were of the ASIA ‘E’ grades. Conclusion: There is a continuum of physical, economic, psychological, and social burdens to both the patients and their care providers. Rehabilitation is the ‘bottleneck’ variable governing poor outcomes in our subcontinents. The poor economic status of the people has a ripple effect upon the same. This should also aid in the patient counseling as well as fostering the notion of the paramount need for dedicated neuro-rehabilitation units in our regions.