The Journal of Bone and Joint Surgery, Vol 67, Issue 2 217-226, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
The management of traumatic spondylolisthesis of the axis
AM Levine and CC Edwards
Fifty-two patients with traumatic spondylolisthesis of the axis were
admitted to the University of Maryland Spinal Injury Center between 1977
and 1982. There were fifteen Type-I fractures, twenty-nine Type-II
fractures, three Type-IIa fractures, and five Type-III fractures.
Associated neurological deficits were found in only four patients, although
unassociated neurological deficits such as closed head injury were seen in
eleven patients. Thirteen patients had other fractures of the cervical
spine. Type-I fractures were stable injuries and were treated with collar
protection. Most Type-II injuries were reduced with the patient in halo
traction, and then immobilization in a halo vest was used. Type-IIa
injuries, as they showed increased displacement in traction, were reduced
with gentle extension and compression in a halo vest. Type-III injuries
were grossly unstable and required surgical stabilization. All of the
fractures healed, although the use of early halo-vest immobilization for
displaced fractures resulted in significant residual deformity. The
radiographic patterns of the fracture types and the resulting data on
clinical stability suggested a correlation between the fracture type and
the mechanism of injury. Type-I injuries resulted from a
hyperextension-axial loading force; Type-II injuries, from an initial
hyperextension-axial loading force followed by severe flexion; Type-IIa
injuries, from flexion-distraction; and Type-III injuries, from
flexion-compression.
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