title: Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases.
abstract: Current treatment regimens for hangman's fracture, or traumatic spondylolisthesis of the axis, emphasize rigid immobilization using a halo orthosis. A retrospective study was undertaken to assess the safety and efficacy of nonrigid immobilization in the treatment of these fractures. Records of 64 patients with hangman's fracture treated over a 19-year period (1975-1994) at one institution were reviewed. Thirty-nine of these patients presented with a displacement of C-2 onto C-3 measuring less than 6 mm and no contiguous cervical fractures. All these patients were treated with nonrigid immobilization, consisting primarily of a Philadelphia hard collar worn for 10 to 14 weeks; all showed stable fracture healing on follow-up flexion-extension radiographs. None of the patients experienced neurological sequelae or significant disability at follow-up review. The results of this series indicate that the majority of patients with hangman's fractures, including all patients with displacement measuring less than 6 mm and no contiguous fractures, may be treated successfully with nonrigid immobilization. This management regimen avoids the increased morbidity and cost associated with rigid immobilization using a halo orthosis.
authors.affiliation: Department of Neurosurgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA.
authors.forename: D
authors.initials: D
authors.lastname: Coric
authors.forename: J A
authors.initials: JA
authors.lastname: Wilson
authors.forename: D L
authors.initials: DL
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001368:Axis, Cervical Vertebra / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*