Traumatic Spondylolisthesis of the Axis

Also known as hangman's fracture, traumatic spondylolisthesis of the axis consists of a bilateral fracture pattern through the pars interar-ticularis or pedicles. The fracture line may involve the superior articular surface or the body of C2. It is also frequently seen as a result of motor vehicle accidents. Clinically, patients rarely have an associated neurological deficit. When a deficit is present, it usually occurs as a result of an associated head injury. Instability can be seen with subluxation of C2 on C3 and associated ligamentous attachment. Four types of injury patterns have been identified (Fig. 22.5) [21].

Type I injuries are those fracture patterns in which there is no angulation of C2 on C3 and less than 3 mm of anterior translation. Type II injuries demonstrate greater than 11° of angula-tion and greater than 3.5 mm of anterior translation. Type IIa injuries, although not associated

Type I Type II Type lia Type III

Fig. 22.5. Classification of hangman's fractures, also known as traumatic spondylolisthesis of the axis. Type I injuries are those fracture patterns in which there is no angulation of C2 on C3 and less than 3 mm of anterior translation. Type II injuries demonstrate greater than 11° of angulation and greater than 3.5 mm of anterior translation. Type IIa injuries, although not associated with significant translation, are associated with a high degree of angulation. Type III injuries, although rare, are associated with not only angulation and displacement, but also with facet dislocations of C2-C3. These could be unilateral or bilateral.

Type I Type II Type lia Type III

Fig. 22.5. Classification of hangman's fractures, also known as traumatic spondylolisthesis of the axis. Type I injuries are those fracture patterns in which there is no angulation of C2 on C3 and less than 3 mm of anterior translation. Type II injuries demonstrate greater than 11° of angulation and greater than 3.5 mm of anterior translation. Type IIa injuries, although not associated with significant translation, are associated with a high degree of angulation. Type III injuries, although rare, are associated with not only angulation and displacement, but also with facet dislocations of C2-C3. These could be unilateral or bilateral.

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