[Traumatic spondylolisthesis of the axis].

PURPOSE OF THE STUDY

The study presents a group of patients with traumatic spondylolisthesis of the axis. Views on the treatment of different types of spondylolisthesis vary. The aim of this study was to carry out a retrospective evaluation of the group of patients with this traumatic condition.

MATERIAL

In the period from 1995 to 2002, 26 patients with traumatic spondylolisthesis of the axis were treated. They accounted for 5% of all patients admitted to our department for cervical spine injuries. Three types of traumatic spondylolisthesis were distinguished according to the Effendi classification. Type I was diagnosed in seven, type II in 18 patients and type III in one patients.

METHODS

Type I traumatic spondylolisthesis was, as a rule, treated conservatively. A halo vest was used in four and a Philadelphia collar in three patients. Patients diagnosed with type II spondylolisthesis were treated surgically from the anterior approach (16 patients) or with a halo vest (two patients). The only patient with a type III fracture was operated on from the anterior approach.

RESULTS

Osseous healing was achieved in all patients. No pseudoarthrosis developed and no repeat surgery for infection or osteosynthesis failure was needed. No deterioration of neurological findings was recorded. The range of motion in the cervical spine after healing was not affected.

DISCUSSION

Views on the classification and therapy of traumatic spondylolisthesis of the axis are diverse. The greatest diversity is associated with making a decision on whether the injury is unstable and requires surgical treatment or not. Further arguments are related to the use of the most suitable approach. Treatment from the anterior approach is prevailing. Type III fractures are rare and must always be treated surgically.

CONCLUSIONS

Methods for treatment of traumatic spondylolisthesis of the axis are currently a topic of dispute. The decisive factor for therapy is whether the injury is stable or unstable. When instability is present, anterior C2-3 spondylodesis completed with plate osteosynthesis is the method of choice. Stable injuries are treated by the application of a halo vest or Philadelphia collar.