Congenital for Spondylolysis or Spondylolisthesis

Type I. Dysplastic: This type results from congenital abnormalities of the upper sacral facets or inferior facets of the fifth lumbar vertebra that allow slipping of L5 on S1. There is no pars interarticularis defect in this type. The sacrum is not strong enough to withstand the weight and stress. Thus, the pars and inferior facets of L5 are deformed. If the pars elongates, it is impossible to differentiate it by x-ray from the isthmic (type II b) Spondylolisthesis. If the pars separates, it becomes impossible to differentiate it by x-ray from the isthmic lytic (type II a) Spondylolisthesis. This type is also associated with sacral and neural arch deficiencies. It has a familial tendency.

Traumatic Spondylolisthesis of the Axis — NEJM

Repetitive trauma in clinical onset or aggravation of Spondylolisthesis and/or Spondylolysis

Traumatic Spondylolisthesis of the Axis

Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations.

5 Traumatic Spondylolisthesis of the Axis (Hangman’s Fracture) D

The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2–C3 disk is essential. Although its synonym “hangman's fracture” suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2–C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2–C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2–C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2–C3 disk, which is usually regarded as stable and therefore might be treated conservatively.

Early halo immobilization of displaced traumatic spondylolisthesis of the axis.
To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis.

referred to more precisely as traumatic spondylolisthesis

Signs/symptoms of Spondylolisthesis and/or Spondylolysis at the time of the repetitive trauma, or within 2 to 3 days of cessation of the trauma;

Spondylolisthesis includes:

Traumatic spondylolisthesis of C2.

In Spondylolysis, symptoms are often absent. Defects are then discovered only incidentally on x-ray made for other purposes. In Spondylolisthesis, injury may aggravate (permanently worsen) any symptoms, but rarely does a single injury cause symptoms in a person who previously had none. Symptoms generally begin insidiously during the second or third decade as an intermittent dull ache in the lower back, present with increasing frequency during walking and standing. Later, pain may develop in the buttocks and thighs, and still later unilateral sciatica may develop.

Spondylolisthesis refers to the forward slippage of one vertebral body with respect to the one beneath it.

Traumatic spondylolisthesis of C2

Narrative review. To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis. Literature review using PubMed, Google Scholar, and Cochrane databases. The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2–C3 disk is essential. Although its synonym “hangman's fracture” suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2–C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2–C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2–C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2–C3 disk, which is usually regarded as stable and therefore might be treated conservatively. Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations.