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Traumatic spondylolisthesis of axis: clinical and imaging experience at a level one trauma center

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Abstract

Purpose

Traumatic spondylolisthesis of the axis (TSA) with bilateral pars interarticularis fracture (a pattern also known as Hangman’s fractures) accounts for 4–5% of all cervical fractures. Various classification systems have been described to assist therapeutic decision-making. The goal is to reassess the utility of these classifications for treatment strategy and evaluate additional imaging associations.

Methods

This is an IRB approved, retrospective analysis of patients with imaging diagnosis of TSA from 2016 to 2019. Consensus reads were performed classifying TSA into various Levine and Edwards subtypes and typical vs. atypical fractures. Other imaging findings such as additional cervical fractures, traumatic brain injury, spinal cord injury, and vertebral artery injury were recorded. Treatment strategy and outcome were reviewed from clinical charts. Fisher exact test was used for statistical analysis.

Results

A total of 58 patients were included, with a mean age of 62.7 ± 25 years, and male to female ratio of 1:1.2. Motor vehicle collision was the most common cause of TSA. Type I and III injuries were the most and the least common injuries, respectively. Patients with type I injuries were found to have good healing rates with conservative management (p < 0.001) while type IIa and III injuries were managed with surgical stabilization (p = 0.04 and p = 0.01, respectively). No statistical difference was observed in the treatment strategy for type II fractures (p = 0.12) and its prediction of the associated injuries. Atypical fractures were not found to have a higher incidence of SCI (p = 0.31). A further analysis revealed significantly higher-grade vertebral artery injuries (grades III and IV according to Biffl grading) in patients with type IIa and III injuries (p = 0.001) and an 11-fold increased risk of TBI compared to type I and type II fractures (p = 0.013).

Conclusion

TSA fracture types were not associated with any clinical outcome. Levine and Edwards type II classification itself is not enough to guide the treatment plan and does not account for associated injuries. Additional imaging markers may be needed.

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Abbreviations

TSA:

Traumatic spondylolisthesis of the axis

SCI:

Spinal cord injury

TBI:

Traumatic brain injury

VAI:

Vertebral artery injury

BCVI:

Blunt cerebrovascular injury

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Author notes

  1. Yu Cai and Shekhar Khanpara contributed equally.

Authors and Affiliations

  1. Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Medical Center at Houston, 6411 Fannin St, Houston, TX, 77030, USA

    Yu Cai, Shekhar Khanpara, David Timaran, Susanna Spence, Jennifer McCarty, Azin Aein, Luis Nunez, Octavio Arevalo & Roy Riascos

  2. Department of Radiology, Louisiana State University at Shreveport, Shreveport, USA

    Octavio Arevalo

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  1. Yu Cai
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  2. Shekhar Khanpara
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  3. David Timaran
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  4. Susanna Spence
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  5. Jennifer McCarty
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Correspondence to Roy Riascos.

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Informed consent was waived by the local institution review board (IRB) due to its retrospective nature.

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Cai, Y., Khanpara, S., Timaran, D. et al. Traumatic spondylolisthesis of axis: clinical and imaging experience at a level one trauma center. Emerg Radiol 29, 715–722 (2022). https://doi.org/10.1007/s10140-022-02041-5

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  • DOI: https://doi.org/10.1007/s10140-022-02041-5

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