title: C4-C5 post-traumatic spondyloptosis with in situ fusion: systematic literature review and case report.
abstract: METHODS
  A case report with systematic review of the literature.
  
  
  OBJECTIVE
  To report a case of post-traumatic C4-C5 spondyloptosis without neurological deficit not associated with posterior element fractures and presenting in a delayed fashion with fusion in situ of C4 and C5 vertebral bodies influencing the management strategy.
  
  
  BACKGROUND
  Traumatic spondyloptosis of the subaxial cervical spine is typically associated with neurological injury. To the best of the author's knowledge, this is the first case of spondyloptosis not associated with fractures of the posterior elements but with locked facets at C4-C5 and fusion in situ, presenting in a delayed fashion with remarkable paucity of symptoms that was managed surgically.
  
  
  METHODS
  A 45-year-old male presented 8 months after a motor vehicle collision with radicular arm pain and mild spasticity involving the legs. Cervical radiograph, computed tomographic scan, and magnetic resonance image revealed bilateral locked facets at C4-C5 with spondyloptosis. Fusion had occurred in situ.
  
  
  RESULTS
  Traction did not correct alignment and the patient underwent circumferential reduction and fusion and postoperative halo-vest placement. At 6-month follow-up, the patient remained neurologically intact with regression of preoperative symptoms.
  
  
  CONCLUSIONS
  Longstanding post-traumatic spondyloptosis may lead to fusion in situ complicating the surgical management. Insufficient suspicion during workup can lead to the omission of this important diagnosis, further complicating operative intervention. Traction is not useful when in situ fusion has occurred in delayed presentation cases.
  
  
  METHODS
  N/A.
authors: Division of Neurosurgery, University of Texas Medical Branch, Galveston, TX 77555, USA. jagascot@utmb.edu
authors: Jaime
authors: J
authors: Gasco
authors: Daniel J
authors: DJ
authors: Dilorenzo
authors: Joel T
authors: JT
authors: Patterson
mesh_terms: D000063:Accidents, Traffic; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013168:Spondylolisthesis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome