Traumatic Lateral Spondyloptosis of the Lumbar Spine: A Case Series and Comprehensive Literature Review

L. Erin Miller MD — 2024-07-22

Introduction: Lateral spondyloptosis of the lumbar spine is a rare and devastating form of traumatic spinal injury. Given the paucity of lumbar lateral spondyloptosis case reports in the literature, the authors seek to inform readers of the clinical, radiological, and operative considerations for three patients with this uncommon clinical presentation, as well as provide a comprehensive review of the literature on this topic.

Methods: A retrospective chart review of three patients admitted to Regional One Health Elvis Presley Memorial Trauma Center in Memphis, TN, with traumatic lateral spondyloptosis of the lumbar spine over a three-year period was performed. We also conducted a comprehensive review of the literature on traumatic lateral lumbar spondyloptosis.

Results: Three cases of traumatic lateral lumbar spondyloptosis were identified. Clinical presentation, radiographic findings, and operative considerations are presented.

Conclusions: Traumatic lateral lumbar spondyloptosis is a rare form of translation injury associated with severe neurological deficits. Our experience and thorough literature review broadly advocate for early surgical intervention in these patients. Regardless of whether a neurologic exam is presented, this management strategy may improve neurologic motor outcomes.

Does Routine Post-Operative Use of Drainage in Minimally Invasive Lumbar Spine Surgery Offer Better Results?

Alexandros Moniakis MD, MSc — 2024-07-22

Objective: The advantages of minimally invasive spine surgery (MISS) in lumbar degenerative diseases have been well described (less tissue damage, shorter hospital stay, better results in pain assessment). One aspect that has not yet been studied enough is the usage of a post-operative drain in MISS. The aim of this study was to determine whether drainage in MISS is necessary or not and what advantages or disadvantages its use offers.

Materials - Methods: We conducted a systematic review of the published literature, searching articles published on Pubmed and Embasse until December 1st 2022, regarding MISS in the lumbar region and post-operative drain usage. Our inclusion criteria were original articles written in English and articles using minimally invasive techniques (usage of tubular retractors along with an endoscope or microscope, paramedian incision, percutaneous screw placement). 42 articles were assessed, and after careful examination and duplication exclusion, 26 research papers were included. Usage, type and duration of postoperative drainage, length of hospital stay, ambulation time and complications were extracted, and relevant results were pooled.

Results: The majority of the included articles (80.7 %) reported using a negative-pressure post-operative drain tube. Drains were removed either 48 hours after surgery or when the drainage volume was less than 50ml/24h. Hospital stays and time to ambulation were shorter in cases where drainage was not used. There was no difference in complications between cases where drainage was used and those that it was not.

Conclusion: The rationale behind post-operative drainage in MISS is to protect from surgical site infections and hematoma creation. Based on our study there is no evidence to support this hypothesis. On the contrary, our results suggest that the drawbacks of using a drain (pain, discomfort, anxiety, inconvenience of mobilisation, prolongation of hospitalisation) outweigh the advantages, thus making the routine use of postoperative drainage in MISS unnecessary.

Journal of Spine Practice (JSP)

Traumatic Lateral Spondyloptosis of the Lumbar Spine: A Case Series and Comprehensive Literature Review

Does Routine Post-Operative Use of Drainage in Minimally Invasive Lumbar Spine Surgery Offer Better Results?