A single-stage three-rod system for sequential reduction of traumatic thoracic spondyloptosis: illustrative case.

BACKGROUND: Spondyloptosis is defined as more than 100% subluxation of adjacent vertebral bodies. Timely reduction and stabilization are important to promote rehabilitation and improve quality of life. OBSERVATIONS: A 32-year-old male sustained a sagittal T9-10 spondyloptosis in a bicycle accident. To reduce the dislocation, the authors used a posterior three-rod construct: one continuous rod secured caudal to the injury site and two temporary short rods placed on the contralateral side flanking the fracture for sequential distraction. This approach involved minimal bony removal, and reduction was accomplished in less than 20 minutes after initial exposure. Postoperative imaging showed stable, near-complete reduction (from grade V to grade I). The patient was discharged on postoperative day 9. At the 4-month follow-up, he regained toe movement and sphincter reflex and had increased trunk control. A literature review of 25 case reports/series involving 42 patients with thoracic spondyloptosis showed that more than 50% of patients required substantial bony resection during reduction. LESSONS: This case highlights the advantages of a posterior three-rod construct in a trauma setting to achieve rapid and controlled spondyloptosis reduction with minimal osteotomy. The selection of reduction techniques should consider injury characteristics, the patient's preoperative neurological status, and the time from initial injury to surgery. https://thejns.org/doi/10.3171/CASE25531.