Abstract
The axis is anatomically, developmentally and biomechanically unique from the five lower cervical vertebrae as well as the axis above it. The pars interarticularis is a transitional structure and a thin tube of cortical bone with small amount of cancellous bone. The canal-to-cord ratio is extremely large, hence the minimal risk of neurological deficit after injury.
Objective:
To report long-term, minimum 5 years, clinical and radiological outcome of our series of patients with traumatic spondylolysthesis of the axis managed non-operatively
Method and material:
Thirty patients had traumatic spondylolysthesis of the axis over a period of five years (January 2005 to December 2010). There were 22 males and eight females with an average age of 36 years. Plain X-rays and CT scans were obtained to evaluate the injury. All patients were managed non-operatively.
Results:
The majority (90%) of the fractures were Type I and type II traumatic spondylolistheses of the axis. The fractures were managed with Philadelphia collars and soft collars. All fractures healed uneventfully. The union rate approached 100%. Patients had excellent range of neck movements. Less than one percent of the patient had a type III traumatic spondylolysthesis of the axis with unifacet dislocation. None of them had neurological fallout.
Conclusion:
Most patients with these injuries can be treated nonoperatively and heal well. It is uncommon for these patients to have neurological deficits. The only absolute indication for operative treatment is the small group with type III traumatic spondylolysthesis associated with bilateral facet dislocation.
