Surgical Reduction Techniques and Outcomes for Cervical Spondyloptosis: A Technical Report and Case Series

BACKGROUND AND OBJECTIVES: Cervical spondyloptosis, defined as Grade V spondylolisthesis with complete vertebral body displacement, represents the most severe form of spinal trauma with fewer than 100 cases reported in literature. Despite increasing case reports, optimal surgical management remains controversial, with significant heterogeneity regarding reduction techniques and stabilization approaches. METHODS: We present 2 distinct patients with traumatic C7-T1 cervical spondyloptosis treated at our institution between 2021 and 2023, with differences in neurological presentation and fracture morphology that influenced management decisions. Comprehensive literature review analyzed predictive factors for reduction success and surgical approach selection. RESULTS: Both patients achieved successful anatomic reduction and stabilization. However, neurological outcomes were variable and correlated with initial injury severity. Patient 2 (American Spinal Injury Association C) progressed to near-complete recovery (4+/5 grip strength only) by the 6-month follow-up, while the Patient 1 (American Spinal Injury Association A) showed no motor recovery at the 4-week follow-up and was subsequently lost to long-term care. No hardware failure or loss of reduction occurred. Literature analysis revealed that facet joint morphology is the primary predictor of closed reduction success, with locked facets necessitating open reduction in 67% of cases. CONCLUSION: Cervical spondyloptosis requires individualized surgical planning based on 2 critical decision points: reduction success (predicted primarily by facet joint integrity) and stabilization strategy selection. Single-approach techniques are sufficient when complete closed reduction is achieved, while combined approaches provide optimal stability for complex cases, particularly at the cervicothoracic junction. While successful anatomic reduction can be achieved, neurological recovery remains highly variable and primarily dependent on initial injury severity.