[Traumatic spondylolisthesis of the axis: arguments in favor of surgical management after analysis of 8 patients].
OBJECTIVE
The purpose of this report is to assess the efficacy of primary surgical stabilization in the management of traumatic C2 spondylolisthesis.


METHODS
Eight patients including 5 men and 3 women (mean age, 44 years) were treated surgically for traumatic spondylolisthesis of the axis. Three patients presented permanent neurological deficit. The indication for operative treatment included fracture instability and association with either neurological deficit or multiple trauma. External immobilization was attempted and failed in two patients. In all cases the procedure was performed by the anterior route and consisted of surgical fixation with C2/C3 discectomy, intersomatic graft placement, and bone fusion.


RESULTS
Using the Effendi and Levine classification, fractures were classified as type I in 2 cases, type II in 3, type IIa in 2, and type III in 1. The two patients with severe tetraparesis presented spinal cord contusion at the C2/C3 disk level. Postoperative radiography demonstrated C2/C3 fusion in all patients. No surgical complications were observed. The average hospital stay was 4.5 days.


CONCLUSIONS
Surgical stabilization by C2-C3 fusion via the anterior route is effective for management of all types of traumatic C2 spondylolisthesis. It achieves immediate stability. We recommend its use as a primary intervention not only for unstable lesions but also for lesions associated with neurological deficits or multiple trauma. A major benefit is to facilitate nursing care and patient rehabilitation.
Service de Neurochirurgie, CHU de La Timone, rue Saint-Pierre, 13385 Marseille Cedex 5. sfuentes@ap-hm.fr
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Fuentes
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Metellus
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Dufour
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Fesselet
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Grisoli
D000328:Adult; D001368:Axis, Cervical Vertebra / Q000293:injuries / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013123:Spinal Fusion; D013124:Spinal Injuries / Q000150:complications / Q000601:surgery*; D013168:Spondylolisthesis / Q000150:complications / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome