Residual neck pain after traumatic spondylolisthesis of the axis.
OBJECTIVE
Most patients with traumatic spondylolisthesis of the axis are treated nonsurgically. Some patients do not develop symptoms, but others experience strong and persistent neck pain. To clarify the factor that plays a major role in residual neck pain after this fracture, we reviewed nine patients who underwent conservative treatment.


METHODS
Patients were assessed via telephone interviews an average of 62 months after injury and were divided into two groups: those with and those without neck pain. Angulation and anterior translation between the second and third cervical vertebrae were measured on lateral radiograms at the time of injury, removal of brace, and final follow-up. Fracture lines were also investigated by computed tomography.


RESULTS
At the time of final follow-up, the average angulation was 6.3 degrees and the average translation was 5.3 mm in the neck-pain group and 0.6 degrees and 0.2 mm, respectively, in the no-symptom group. In patients with fracture lines present on the articular surface of the inferior face joints, angulation persisted or increased, even though the fractures were hemilateral. This was compatible with severe neck pain. In contrast, angulation and translation were improved in patients with an intact inferior articular surface of the axis, and pain was not reported.


CONCLUSIONS
Injury on the inferior articular surface of the axis may disturb spontaneous healing of C2-C3 subluxation and cause residual neck pain. It is necessary to assess the presence of injury to the inferior facet bilaterally with plain or computed tomograms.
Watanabe
Masahiko
M
Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan. masahiko@is.icc.u-tokai.ac.jp
Nomura
Takeshi
T
Toh
Eiren
E
Sato
Masato
M
Mochida
Joji
J
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D016267:External Fixators; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D013123:Spinal Fusion / Q000592:standards / Q000706:statistics & numerical data; D013168:Spondylolisthesis / Q000150:complications* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure