External Femoral Traction for Reduction of Traumatic Lumbar Spondyloptosis: A Technical Note

Traumatic lumbar spondyloptosis is a rare entity associated with high-velocity mechanisms and is the most severe form of lumbar spondylolisthesis. Operative management is often required; however, the relative merits of reduction versus in situ fusion remain debated, largely owing to the technical difficulty of attaining satisfactory fracture reduction. In this report, we describe external femoral traction as a novel technique for closed reduction of traumatic lumbar spondyloptosis. A 27-year-old man presented after a tree he was cutting fell on him and was found to have T3–7 AO Spine (AOS) A1 fracture, L3 AOS B2 fracture, and L5 AOS C fracture. Neurologic exam was consistent with multilevel nerve root injury. Definitive treatment included bilateral femoral traction, open reduction, and combined anterior/posterior fixation. A multidisciplinary team including orthopedic surgery, plastic surgery, vascular surgery, and neurosurgery were involved. Complete reduction was obtained, and the patient experienced near-complete resolution of neurologic symptoms. This technique offers a unique solution to the challenge of traumatic lumbar spondyloptosis. Further study and follow-up are needed to confirm the utility and durability of this technique and the cranial extent of injury for which this technique might be applied.