Traumatic lumbar spondyloptosis, surgical challenges in a low-resource setting: a case report
Emmanuel L. Sule, Madai Mparazo, Honest H. Massawe, Mathias S. Ncheye, Gosbert George, Peter M. MrimbaIntroduction:
Traumatic lumbar spondyloptosis is a rare, highly unstable spinal injury caused by high-energy trauma and is commonly associated with complete neurological deficit. Management is particularly challenging in low-resource settings where access to timely surgery may be limited. We report a rare case of traumatic L1–L2 spondyloptosis managed despite a 2-week delay in definitive surgery due to financial constraints.
Case presentation:
A 26-year-old woman sustained traumatic L1–L2 spondyloptosis following a road-traffic accident and presented with complete paraplegia (ASIA Grade A). Computed tomography confirmed complete vertebral dislocation. Surgery was delayed for 2 weeks because of financial constraints affecting implant procurement. During this period, comprehensive spinal cord injury care, including pressure sore prevention, deep vein thrombosis prophylaxis, bladder and bowel management, chest physiotherapy, pain control, nutritional support, and regular neurological assessment, prevented major complications. Once implants became available, she underwent posterior open reduction and long-segment pedicle screw fixation from T11 to L4. Postoperative rehabilitation included physiotherapy, occupational therapy, bladder and bowel care, and psychological support. At discharge and 4-week follow-up, neurological status remained ASIA A; however, spinal alignment was restored, pain was controlled, the wound healed satisfactorily, and the patient achieved improved sitting balance and wheelchair mobility.
Discussion:
This case highlights the importance of comprehensive multidisciplinary care when definitive surgery for traumatic lumbar spondyloptosis is unavoidably delayed. Standard spinal cord injury care prevented complications associated with prolonged immobilization and enabled safe, definitive treatment. Although neurological recovery was not achieved, surgical stabilization restored spinal stability and facilitated rehabilitation and functional independence. This case also contributes to the limited literature on traumatic lumbar spondyloptosis from sub-Saharan Africa.
Conclusion:
Traumatic lumbar spondyloptosis is a severe spinal injury requiring surgical stabilization and multidisciplinary care. In low-resource settings, appropriate spinal cord injury care during unavoidable surgical delays can prevent secondary complications and facilitate definitive treatment. Even when neurological recovery is not achieved, surgical stabilization can restore alignment, improve pain control, and support rehabilitation and functional independence.