Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal

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They invariably become socially aloof and marginalized in most parts of our subcontinent owing to the lack of dedicated rehabilitation units amid their poor economic status. There is a paucity of studies pertaining to such rare epiphenomenon within our region. Materials ad Methods A retrospective study of 16 patients presenting with spinal spondyloptosis in a tertiary care center in Nepal was undertaken. The clinical records of the patients were retrieved from the hospital record section to study the demographic variables, modes of injury, American Spinal Injury Association (ASIA) grades, salient radiological characteristics, management strategies, and the resultant clinical outcomes. Result The mean age of the cohorts in our study was 40 years with an age range of 25-80 years. Most of the patients presented in ASIA ‘A’ neurological grade (75%). The cervical spine was involved in the majority (68.75%) of cases. 8 (50%) patients left against medical advice, 2 (12.5%) were managed conservatively, and 6 (37.5%) were operated. The posterior-only approach was undertaken in 4(66.67%) cases. Tracheo-oesophageal fistula occurred in 2 (33.33%) patients. And cerebrospinal fluid (CSF) leak occurred in 2 (33.33%) patients. The overall hospital mortality was 3(37.5%). Conclusion Traumatic spinal spondyloptosis on our center mostly involved cervical spine (68.75%). 75% of the patients presented with ASIA ‘A’ neurological grade. 50% of them left against medical advice. 37.5% were operated. The overall hospital mortality was 37.5%. This study emphasizes the implementation of a national spinal trauma data bank and the systematic implementation of dedicated neuro-rehabilitation units. This will thereby help improve the clinical outcome among these ‘socially aloof’ and marginalized subsets of neurosurgical patients. 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F1000Research 2025, 12 :474 ( https://doi.org/10.12688/f1000research.133377.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] Sunil Munakomi https://orcid.org/0000-0001-6079-3792 Sunil Munakomi https://orcid.org/0000-0001-6079-3792 PUBLISHED 02 Jun 2025 Author details Author details Neurosurgery, College of Medical Sciences, Chitwan, Nepal Sunil Munakomi Roles: Conceptualization, Data Curation, Investigation, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Traumatic spinal spondyloptosis, though rare, harbingers a high risk of mortality as well as permanent and disabling neurological deficits. They invariably become socially aloof and marginalized in most parts of our subcontinent owing to the lack of dedicated rehabilitation units amid their poor economic status. There is a paucity of studies pertaining to such rare epiphenomenon within our region. Materials ad Methods A retrospective study of 16 patients presenting with spinal spondyloptosis in a tertiary care center in Nepal was undertaken. The clinical records of the patients were retrieved from the hospital record section to study the demographic variables, modes of injury, American Spinal Injury Association (ASIA) grades, salient radiological characteristics, management strategies, and the resultant clinical outcomes. Result The mean age of the cohorts in our study was 40 years with an age range of 25-80 years. Most of the patients presented in ASIA ‘A’ neurological grade (75%). The cervical spine was involved in the majority (68.75%) of cases. 8 (50%) patients left against medical advice, 2 (12.5%) were managed conservatively, and 6 (37.5%) were operated. The posterior-only approach was undertaken in 4(66.67%) cases. Tracheo-oesophageal fistula occurred in 2 (33.33%) patients. And cerebrospinal fluid (CSF) leak occurred in 2 (33.33%) patients. The overall hospital mortality was 3(37.5%). Conclusion Traumatic spinal spondyloptosis on our center mostly involved cervical spine (68.75%). 75% of the patients presented with ASIA ‘A’ neurological grade. 50% of them left against medical advice. 37.5% were operated. The overall hospital mortality was 37.5%. This study emphasizes the implementation of a national spinal trauma data bank and the systematic implementation of dedicated neuro-rehabilitation units. This will thereby help improve the clinical outcome among these ‘socially aloof’ and marginalized subsets of neurosurgical patients. READ ALL READ LESS Keywords spondyloptosis, presentation, management, outcome Corresponding Author(s) Sunil Munakomi ( [email protected] ) Close Corresponding author: Sunil Munakomi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Munakomi S. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Munakomi S. Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.12688/f1000research.133377.3 ) First published: 09 May 2023, 12 :474 ( https://doi.org/10.12688/f1000research.133377.1 ) Latest published: 02 Jun 2025, 12 :474 ( https://doi.org/10.12688/f1000research.133377.3 ) Revised Amendments from Version 2 We have revised the paper as per the suggestions provided by the reviewers: Keywords have been modified. The preoperative MRI images have been included. The post-operative photos have been included. The sample size is mentioned to increase the statistical significance of our study, as it is a rare entity. The study has been changed to an observational study. The current status of all the patients presenting with ASIA ‘E’ status has been included in the result section. We have revised the paper as per the suggestions provided by the reviewers: Keywords have been modified. The preoperative MRI images have been included. The post-operative photos have been included. The sample size is mentioned to increase the statistical significance of our study, as it is a rare entity. The study has been changed to an observational study. The current status of all the patients presenting with ASIA ‘E’ status has been included in the result section. To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction H.W. Meyerding first described spondyloptosis in 1938. 1 This is the most severe and unstable variant of translational injury that can that invariably leads to complete cord transection (above 70% cases) and ominous to permanent neurological deficits. 2 The survivors are compelled to be dependent on others for lifelong even for carrying out their activities of daily living (ADLs). They invariably become socially aloof and marginalized in most parts of our subcontinent owing to the lack of dedicated rehabilitation units amid their poor economic status. Since the majority of these cohorts present with poor American Spinal Injury Association (ASIA) neurological grades, the surgical dictum mostly involves anatomical fixation to assist in their early rehabilitative strategies. The combined anterior and posterior approaches are recommended only in rare circumstances for patients presenting with good ASIA neurological grades. There is a paucity of studies pertaining to such rare epiphenomenon within our region. This study should provide insights to help frame the management algorithm among similar cohorts of patients. This will also aid in the process of patient counseling as well as foster the notion of the paramount need for dedicated neuro-rehabilitation units in our regions. Methods An observational study of consecutive cohorts of patients presenting with spinal spondyloptosis in the Emergency Department of the College of Medical Sciences was undertaken. Spondyloptosis was defined on radiological imaging (X-ray/CT/MRI) of the spine as >100% subluxation between the adjacent vertebra. The images of spondyloptosis at different levels of the spine have been demonstrated in Figures 1 and 2 . Figure 1. CT images of spondyloptosis at various anatomical levels of spine. Figure 2. MRI images of spondyloptosis at various anatomical levels of spine. The clinical records of the patients were retrieved from the hospital record section to study the demographic variables, modes of injury, American Spinal Injury Association (ASIA) grades, salient radiological characteristics, management strategies, and the resultant clinical outcomes. The sample size for the study was calculated for statistical significance by: n = z 2 × p q / d 2 = 1.96 × 1.96 × 0.01 × 0.99 / 0.05 × 0.05 = 15.21 , wherein n = minimum required sample size z = 1.96 at 95% Confidence interval (CI) p = reported incidence of spondyloptosis (p) at 1% q = 1-p, and d = margin of error at 5%. The sample size of the study was 16 patients. The data collected was collected and descriptive statistics were applied using the Microsoft Excel spreadsheets. The frequency distribution charts were obtained in terms of counts and percentages for each relevant variable. All their clinical and radiological data are anonymously presented in the study. The study was approved by the institutional ethical review committee of College of Medical Sciences and Teaching Hospital (IRC–COMSTH-IRC/2023-08). This study was conducted from 3rd March 2023 to 21st March 2023. Results The mean age of the cohorts in our study was 40 years with an age range of 25-80 years. There was a male preponderance with a male:female ratio of 15:1. Spondyloptosis was secondary to road traffic accidents in nine (56.25%) and fall incidents in seven (43.75%). Most of the patients presented in ASIA ‘A’ neurological grade (75%) baring one (6.25%) patient in ASIA ‘B’ and three (18.75%) cases in ASIA ‘E’ neurological grades. The cervical spine was involved in the majority (68.75%) of cases. The sagittal pattern of spondyloptosis was predominant and observed in 14 patients (87.5%). Eight (50%) patients left against medical advice after understanding the poor prognosis of the entity. Two (12.5%) were managed conservatively owing to a moribund state due to pulmonary complications resulting from phrenic nerve injury and lung contusions respectively. Both of them eventually expired, six (37.5%) were operated. The posterior-only approach was undertaken in 4(66.67%) cases. Anterior only and global approach was undertaken in one (16.67%) cases each. Tracheo-oesophageal fistula occurred in two (33.33%) patients. One healed after one month of conservative management with nasogastric tube feeding. The other patient expired secondary to severe mediastinitis. Cerebrospinal fluid (CSF) leak occurred in two (33.33%) patients. No clinical improvements were observed in patients presenting with ASIA ‘A’ neurological grades. The overall hospital mortality was three (37.5%). The operative mortality was one (16.67%). Post-discharge, two (40%) patients eventually expired secondary to sepsis. The results of our study have been summarized in Tables 1 and 2 . Table 1. Anatomical levels of involvement and corresponding clinical ASIA grades. Anatomical level of involvement ASIA ‘A’ ASIA ‘B’ ASIA ‘E’ C2-3 2 C4-5 2 C5-6 2 C6-C7 2 1 C7-T1 2 D3-4 1 D10-11 1 L3-4 1 L5-S1 1 1 Table 2. Demographic, radiological and clinical characteristics of the study cohort. Study variables Categorizations Frequency (percentage) Neurological presentations ASIA ‘A’ 12(75%) ASIA ‘B’ 1(6.25%) ASIA ‘E’ 3(18.75%) Anatomical level of involvement Cervical 9(56.25%) Thoracic 2(12.5%) Lumbar 1(6.25%) Transitional zones 4(25%) Management strategies Left against medical advice 8(50%) Conservative 2(12.5%) Operative 6(37.5%) Surgical approaches Anterior only 1(16.67%) Posterior only 4(66.67%) Global 1(16.67%) Mortality at hospital Surgical 1(16.67%) Overall 3(37.5%) The post operative images of two cases of spondyloptosis presenting with ASIA ‘E’ neurological status have been shown in Figure 3 and 4 . Figure 3. Post operative images of a case managed with both anterior (discectomy, autologous iliac bone grafting with plate and screw fixation) and posterior (lateral mass and trans-laminar screw fixation). Figure 4. Post operative images of a case of C2-C3 spondyloptosis managed with occipito-cervical fusion. Among the operated patients with ASIA ‘E’ neurological status, an 80 years old patient with C2-C3 spondyloptosis survived for 4 years after surgery. The remaining two cases still had ASIA ‘E’ neurological status at the time of last follow up (4 and 6 years after surgery). Discussion A concurrent shearing and axial compression vector disrupts all three Denis columns in spondyloptosis. 3 , 4 The narrower cord to canal ratio and the tenuous blood supply also increases odds to neurological deficits, mostly in thoracic variant. 5 Complete neurological deficit (ASIA’A’) is observed in almost 80% of cases. 6 Saving (free-floating) fractures of the vertebral arch, described by Bohler in 1948, can sometimes enigmatically spare the spinal cord owing to spontaneous decompression. 4 , 5 Motor vehicle accidents and substantial falls mostly accounts for traumatic form of spondyloptosis. 5 This can be anterior (almost 80%), posterior, or lateral relative to the caudal vertebra depending upon the direct of the impact, as described by Denis and Burkus. 7 This mostly often occurs in the transitional spinal regions (C7-T1, T10-L2, L4-S1 and L4/L5). 1 , 7 Furthermore there is least resistance along the first sacral vertebral foramen. 6 Cervical spondyloptosis harbinger risk of injuries to the phrenic nerve and vertebral artery. 2 There is risk of aortic, vena cava, and iliac injuries in thoracic and lumbar variants. 3 Concomitant chest complications, such as rib fractures, pneumothorax, and hemothorax can occur in thoracic spondyloptosis. 5 It is also essential to rule out fractures at non-contiguous spinal regions that can easily get overlooked. 3 There are currently no clear guidelines for the management of traumatic spondyloptosis. 1 Distraction, unlocking, anatomic fixation, and arthrodesis are the dictum of surgical management. 6 The core principle of care is restoration and stabilization of spinal alignment to facilitate early mobilization and rehabilitation in the patient. 2 The risks/benefits ratio governs a significant interplay the management algorithm. 8 Combined 360 degrees and 540 degrees approaches may be justified for circumferential and robust fixation among cohorts with preserved neurology. Traction is first applied to provide stability, minimize pain, and to restore the spinal alignment, especially in cervical spondyloptosis. 5 , 7 The traction is applied 2 cm posterior to the inter-aural line to facilitating flexion. An initial 4 kg followed by gradual increment by 4 kg increments every 20 minutes (max 63 kg) until complete reduction or neurological deterioration (whichever comes earliest) is seen. The posterior variant resulting from the disruption of the soft tissue stabilizers have a high chance of complete reduction following traction. 6 Distraction and unlocking may facilitate intra-operative reduction. 6 A combined anterior and posterior approach fusion, with intra-operative neuro-monitoring is advocated for patients with preserved neurology. 8 Intraoperative axilla-pelvic distraction followed by corpectomy, or spondylectomy with cage placement have been described for thoracic spondyloptosis. 9 Such spinal shortening procedure poses significant risk of injuries to aorta or vena cava during distraction. 9 Similarly, Corpectomy and cage placement at L5-S1 is technically demanding owing to its inherent lordosis. 3 Grob’s, Gaines and Nichols methods have significant surgical risks. 1 Furthermore, pelvic instrumentation may be justified to prevent pseudo-arthrosis. 1 Therefore standalone long-segment posterior instrumentation is often the ‘work-horse’ in the surgical management of thoracic and lumbar spondyloptosis, especially in ASIA ‘A’ and ‘B’ subtypes’, to facilitate their rehabilitative strategies. 3 Standalone anterior or posterior approaches may be justified in cervical spondyloptosis with similar neurological status depending upon the reducibility of the subluxation after traction. In the largest series comprising 20 patients, the mean age of the cohorts was 27 years with a male: female ratio of 5.6:1. 10 The systematic review of cervical spondyloptosis also had a male preponderance of 70% with a mean age of 41 years. 11 In a most recent study comprising 17 patients, the mean age was 34.5 years, male to female ratio of 2.4:1. 7 The mean age of the cohorts in our study was 40 years and the male: female ratio was of 15:1. The most common level of involvement was at T10-L2 (55%), a mechanical transitional zone. 10 Ironically, there was no involvement of the cervical spine in this study, the region of maximum involvement in our study (68.5%). The study pertaining to cervical spondyloptosis had the involvement of the lower cervical spine (C6-C7 and C7-T1) in 68% of cases. 11 The same levels were involved in 45.45% of our study. This may be owing to the higher load with compromised mobility in the region. 5 All the cases presented with ASIA ‘A’ grade in the largest study and therefore were managed by short segment pedicle screw fixation. 10 Three of our cases presented with ASIA ‘E’, and one patient presented with ASIA ‘B’ neurological grades. Similarly, the study relating to cervical spondyloptosis also had 21/66 (31.81%) cases presenting with ASIA ‘E’ grades. 11 Since we had the majority of cases with involvement of the cervical spine, anterior cervical approaches, either standalone or combined, were also adopted. We had CSF leaks in 33.33% of operated cases. The risk of CSF leak may be prevented by ligation of the thecal sac, fibrin glue sealant, and multi-layered wound closure. 10 There is also increased odds of esophageal laceration and vocal cord paralysis during the surgical strategies of the cervical spondyloptosis. 11 Tracheo-oesophageal fistula occurred in two (33.33%) patients in our study. The reported mortality in the systematic review of cervical spondyloptosis was 11%. 11 Two mortalities occurred in the most recent study secondary to pulmonary complications and DVT. 7 The same in our study was 16.67%. Studies have shown no significant differences between the standalone anterior or posterior approaches with combined approaches with regards to improvement in neurology. 7 Similarly, no association has been found between injury to surgery time and outcome. 7 However, duration of injury to surgical time was significantly associated with postoperative residual listhesis. 7 Complete reduction may not be possible despite distraction and corpectomy. 10 Posterior alone approach was used in 93.3% of cases in one series. 7 Multidisciplinary care is prudent for optimal outcomes. 9 The overall prognosis is poor, and this has a continuum and multispectral debilitating impact upon the patient’s quality of life. 1 Bleak outcomes with devastating long-term physical disability and psychosocial sequelae. 88.2% showed no improvement in one study. 7 The long-term prognosis is however abysmal owing to suboptimal home-based care and liberal assess to rehabilitation facilities especially in low income nations. 10 The main cause of mortality during the follow-up visits, mostly secondary to complications of bed sores, has been observed in 25% of patients. Lack of dedicated rehabilitation is the ‘bottleneck’ variable governing poor outcomes in our subcontinents. The poor economic status of the people has a ripple effect upon the same. 10 This is the same reason for almost 50% of our cases leaving against medical advice from our hospital. Despite being a rare clinical entity, a low sample size is a limiting factor of the study. The true incidence of the traumatic spondyloptosis in our region may not be reflected for our single-center data. Conclusion Traumatic spinal spondyloptosis on our center mostly involved cervical spine (68.75%). 75% of the patients presented with ASIA ‘A’ neurological grade. 50% of them left against medical advice. 37.5% were operated. The overall hospital mortality was 37.5%. This study provides insights into the patterns of clinical presentations, radiological characteristics, management strategies, and outcome details of cohorts presenting with traumatic spinal spondyloptosis. This will help formulate management strategies and foster rational counseling. This is one of the first pilot studies to be carried out in the country relating to this rare traumatic spinal entity. This study emphasizes the implementation of a national spinal trauma data bank and the systematic implementation of dedicated neuro-rehabilitation units. This will thereby help improve the clinical outcome among these ‘socially aloof’ and marginalized subsets of neurosurgical patients. Data availability Figshare: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal Item. https://doi.org/10.6084/m9.figshare.22359802.v3 . 12 This project contains the following data: • The data of 16 patients presenting with spondyloptosis in our center. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Bębenek A, Dominiak M, Karpiński G, et al. :Irreducible L5/S1 Spondyloptosis in Over 20 Years After Neglected Trauma Treated with Modified Grob’s Technique - Case Report. Int Med Case Rep J. 2023 Sep 12; 16 :537–543. PubMed Abstract | Publisher Full Text | Free Full Text 2. Kwun JW, Kim SY, Lee SK, et al. :Management of Traumatic Cervical Spondyloptosis with an Unsealable Dura Tear: A Case Report. Korean J Neurotrauma. 2021 Aug 24; 17 (2):180–185. PubMed Abstract | Publisher Full Text | Free Full Text 3. Gabel BC, Curtis E, Gonda D, et al. : Traumatic L5 Posterolateral Spondyloptosis: A Case Report and Review of the Literature.Cureus.2015 June 14; 7 (6): e277. PubMed Abstract | Publisher Full Text | Free Full Text 4. Gitelman A, Most MJ, Stephen M:Traumatic thoracic spondyloptosis without neurologic deficit, and treatment with in situ fusion. Am J Orthop (Belle Mead NJ). 2009 Oct; 38 (10):E162–E165. PubMed Abstract 5. Rahimizadeh A, Rahimizadeh A. Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report.J Neurosurg Spine.2015 Dec; 23 (6):715–720. Publisher Full Text PubMed Abstract | 6. Fattahi A, Daneshi A, Taheri M, et al. :Traumatic Sacral Spondyloptosis; Report of an Extremely Rare Case. Trauma Mon. 2022; 27 (5):606–610. Publisher Full Text 7. Singh R, Prasad RS, Singh A, et al. : Traumatic spondyloptosis: neurological, surgical, and outcome perspectives in a tertiary care center.Indian J Neurosurg.2022; 11 : 232–240. Publisher Full Text , 8. Braithwaite J, Gruber J, Fakhoury J, et al. :Acute Traumatic Spondyloptosis: A Case Report. Cureus. 2023 Mar 21; 15 (3): e36457. PubMed Abstract | Publisher Full Text | Free Full Text 9. Arash Fattahi AD. Traumatic thoracic spine spondyloptosis treated with spondylectomy and fusion.2018 Aug 10; 9 :158. Publisher Full Text 10. Mishra A, Agrawal D, Gupta D, et al. :Traumatic spondyloptosis: a series of 20 patients. J Neurosurg Spine. 2015 Jun; 22 (6):647–652. Epub 2015 Mar 13. PubMed Abstract | Publisher Full Text 11. Khelifa A, Berchiche L, Aichaoui F, et al. :Traumatic cervical spine spondyloptosis: A systematic review. J Craniovertebr Junction Spine. 2022 Jan-Mar; 13 (1):9–16. PubMed Abstract | Publisher Full Text | Free Full Text 12. Sunil MK: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal Item. figshare. Dataset. 2023. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 09 May 2023 ADD YOUR COMMENT Comment Author details Author details Neurosurgery, College of Medical Sciences, Chitwan, Nepal Sunil Munakomi Roles: Conceptualization, Data Curation, Investigation, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 02 Jun 2025, 12:474 https://doi.org/10.12688/f1000research.133377.3 version 2 Revised Published: 07 May 2024, 12:474 https://doi.org/10.12688/f1000research.133377.2 version 1 Published: 09 May 2023, 12:474 https://doi.org/10.12688/f1000research.133377.1 Copyright © 2025 Munakomi S. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Munakomi S. Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.12688/f1000research.133377.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 07 May 2024 Revised Views 0 Cite How to cite this report: Shrestha P. Reviewer Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.165775.r382973 ) The direct URL for this report is: https://f1000research.com/articles/12-474/v2#referee-response-382973 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 May 2025 Pratyush Shrestha , National Institute of Neurological and Allied Sciences, Bansbari, Nepal Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.165775.r382973 1) Why has sample size calculation been done here? This is not a prospective study, readers concentration is misdirected 2) The study reports different patients with different ASIA grades; and different patient receiving different forms of treatment. ... Continue reading READ ALL 1) Why has sample size calculation been done here? This is not a prospective study, readers concentration is misdirected 2) The study reports different patients with different ASIA grades; and different patient receiving different forms of treatment. It would be worthful if the author mentioned which specific patient received which treatment modality. The 3 patients with ASIA E status, how they fared is something every reader would be interested to know. 3) The study concludes on neurorehabilitation and also in the introduction mentions these patients being socially aloof and marginalized; which is not a finding of this study. If the author could have followed these patients in a point in time later, how they fared after the accident, these conclusions would be of value. How long these patients lived, what happened after they left against medical advice would be a great addition on the message the study gives, i.e, the need of a national registry which has rightly been stressed by the author. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: spine and brain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shrestha P. Reviewer Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.165775.r382973 ) The direct URL for this report is: https://f1000research.com/articles/12-474/v2#referee-response-382973 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Dao I. Reviewer Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.165775.r276092 ) The direct URL for this report is: https://f1000research.com/articles/12-474/v2#referee-response-276092 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Jun 2024 Ibrahim Dao , Nazi Boni University, Bobo Dioulasso, Burkina Faso Approved VIEWS 0 https://doi.org/10.5256/f1000research.165775.r276092 Dear editor The author deal with an interesting topic of 16 traumatic spinal spondyloptosis managed in their department including 11 cases of cervical spine. Despite surgical management in some cases, there was any improvement in patient ... Continue reading READ ALL Dear editor The author deal with an interesting topic of 16 traumatic spinal spondyloptosis managed in their department including 11 cases of cervical spine. Despite surgical management in some cases, there was any improvement in patient with ASIA A at presentation. Comments to authors: 1. For a better evaluation of the preoperative lesion above all in cervical spine, did you perform MRI. If yes, you should add some MRI images. If no, explain. 2. Post operative control imaging is very important. Please provides them. 3. Please your keywords did not cope properly with the manuscript. This will make its the research difficult. after Indexing Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Neurosciences I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dao I. Reviewer Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.165775.r276092 ) The direct URL for this report is: https://f1000research.com/articles/12-474/v2#referee-response-276092 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 09 May 2023 Views 0 Cite How to cite this report: KC B. Reviewer Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.146362.r172993 ) The direct URL for this report is: https://f1000research.com/articles/12-474/v1#referee-response-172993 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Dec 2023 Bidur KC , Department of Neurosurgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.146362.r172993 In the material and methods of abstract section, type of study should be mentioned. In the result part of abstract section, last paragraph all the surviving patients were of ASIA grade E ... Continue reading READ ALL In the material and methods of abstract section, type of study should be mentioned. In the result part of abstract section, last paragraph all the surviving patients were of ASIA grade E should be omitted, because this sentence gives a false sense of good prognosis after treatment in patients with spondyloptosis. Conclusion part of abstract section, it is not according to the objective of the study and results of the study. In method section of manuscript, retrospective type of study should be mentioned. Looks like there is a methodological flaw because ethical review committee has approved the study in 2023, sample was taken from January 2017 and in methodology it was written that data were taken from the hospital record section and later part it was mentioned that author has taken verbal and written consent. In the result section of manuscript, as exclusion criteria has mentioned to exclude those patients who went on leave against medical advice but in the data, 8 patient who left against medical advice were also included. So actual study of remaining 8 patients should have been included in the results to match the objective of the study. In the last paragraph instead of writing all surviving patients were of ASIA E grades, mention the exact number of patients because this sentence giving a false sense of good prognosis after treatment in patients with spondyloptosis. Discussion part of manuscript is slightly short, should have been elaborative. Conclusion should be drawn according to the results of manuscript. Must be rewritten. Too few number of references included. If the author make the discussion part elaborative then references will also increase in number. This study is retrospective in nature with only 8 patients available for analysis of final results. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Neurosurgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT KC B. Reviewer Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.146362.r172993 ) The direct URL for this report is: https://f1000research.com/articles/12-474/v1#referee-response-172993 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 09 May 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 02 Jun 25 Version 2 (revision) 07 May 24 read read Version 1 09 May 23 read Bidur KC , Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal Ibrahim Dao , Nazi Boni University, Bobo Dioulasso, Burkina Faso Pratyush Shrestha , National Institute of Neurological and Allied Sciences, Bansbari, Nepal Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Shrestha P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 May 2025 | for Version 2 Pratyush Shrestha , National Institute of Neurological and Allied Sciences, Bansbari, Nepal 0 Views copyright © 2025 Shrestha P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1) Why has sample size calculation been done here? This is not a prospective study, readers concentration is misdirected 2) The study reports different patients with different ASIA grades; and different patient receiving different forms of treatment. It would be worthful if the author mentioned which specific patient received which treatment modality. The 3 patients with ASIA E status, how they fared is something every reader would be interested to know. 3) The study concludes on neurorehabilitation and also in the introduction mentions these patients being socially aloof and marginalized; which is not a finding of this study. If the author could have followed these patients in a point in time later, how they fared after the accident, these conclusions would be of value. How long these patients lived, what happened after they left against medical advice would be a great addition on the message the study gives, i.e, the need of a national registry which has rightly been stressed by the author. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise spine and brain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Shrestha P. Peer Review Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.165775.r382973) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-474/v2#referee-response-382973 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Dao I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Jun 2024 | for Version 2 Ibrahim Dao , Nazi Boni University, Bobo Dioulasso, Burkina Faso 0 Views copyright © 2024 Dao I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear editor The author deal with an interesting topic of 16 traumatic spinal spondyloptosis managed in their department including 11 cases of cervical spine. Despite surgical management in some cases, there was any improvement in patient with ASIA A at presentation. Comments to authors: 1. For a better evaluation of the preoperative lesion above all in cervical spine, did you perform MRI. If yes, you should add some MRI images. If no, explain. 2. Post operative control imaging is very important. Please provides them. 3. Please your keywords did not cope properly with the manuscript. This will make its the research difficult. after Indexing Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Neurosciences I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Dao I. Peer Review Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 12 :474 ( https://doi.org/10.5256/f1000research.165775.r276092) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-474/v2#referee-response-276092 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 KC B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Dec 2023 | for Version 1 Bidur KC , Department of Neurosurgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal 0 Views copyright © 2023 KC B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In the material and methods of abstract section, type of study should be mentioned. In the result part of abstract section, last paragraph all the surviving patients were of ASIA grade E should be omitted, because this sentence gives a false sense of good prognosis after treatment in patients with spondyloptosis. Conclusion part of abstract section, it is not according to the objective of the study and results of the study. In method section of manuscript, retrospective type of study should be mentioned. Looks like there is a methodological flaw because ethical review committee has approved the study in 2023, sample was taken from January 2017 and in methodology it was written that data were taken from the hospital record section and later part it was mentioned that author has taken verbal and written consent. In the result section of manuscript, as exclusion criteria has mentioned to exclude those patients who went on leave against medical advice but in the data, 8 patient who left against medical advice were also included. So actual study of remaining 8 patients should have been included in the results to match the objective of the study. In the last paragraph instead of writing all surviving patients were of ASIA E grades, mention the exact number of patients because this sentence giving a false sense of good prognosis after treatment in patients with spondyloptosis. Discussion part of manuscript is slightly short, should have been elaborative. Conclusion should be drawn according to the results of manuscript. Must be rewritten. Too few number of references included. If the author make the discussion part elaborative then references will also increase in number. This study is retrospective in nature with only 8 patients available for analysis of final results. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise Neurosurgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) KC B. Peer Review Report For: Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal [version 3; peer review: 1 approved, 1 approved with reservations, 1 not approved] . 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