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Traumatic spondylolisthesis of the axis.
The Orthopedic Clinics of North America
|October 1, 1978
Summary
Cervical spine fractures at C2 from hyperextension injuries, common in accidents, differ from judicial hangings. Motor vehicle accidents often cause hyperextension with axial compression, leading to fewer neurological issues.
Area of Science:
- Orthopedics
- Traumatology
- Forensic Pathology
Background:
- Cervical spine injuries, particularly at the C2 level, can result from various trauma mechanisms including motor vehicle accidents, diving incidents, and falls.
- These injuries share radiographic similarities with lesions observed in judicial hangings, necessitating careful differentiation.
Observation:
- Hyperextension injuries of the cervical spine in motor vehicle accidents typically involve axial compression rather than distraction.
- Axis pedicle fractures are frequently associated with facial and scalp injuries.
Findings:
- The mechanism of hyperextension with axial compression in motor vehicle accidents is linked to a lower incidence of neurological deficits compared to other hyperextension injury mechanisms.
- Fracture union is generally expected, with rare late sequelae.
Implications:
- Non-operative management, including cervicothoracic bracing or halo immobilization for unstable fractures, is often effective.
- A 12-week immobilization period is recommended for optimal union.
- Surgical intervention, preferably an anterior approach with interbody fusion, may be considered for complex cases.