How are traumatic spondylolisthesis C2 fractures treated?

Updated: Sep 28, 2020
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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Treatment of type I fractures usually is with a Philadelphia collar or halo.

Several treatment options are available for type II fractures, the first being conservative external fixation with halo or tong traction in weighted extension for 1 week. If reduction is acceptable (with less than 4 mm of displacement and less than 10 degrees of angulation), treatment progresses with halo-vest immobilization for 12-16 weeks. If reduction is unacceptable, weighted extension traction resumes for up to 6 weeks, followed by halo treatment for 6 weeks. If adequate results are not achieved after closed reduction and traction, open reduction with anterior cervical plating is the next step.

The other surgical treatment option consists of weighted extension traction to accomplish adequate reduction, followed by internal fixation with a C2 transpedicular screw. Conservative and surgical treatments typically yield excellent results. [11, 15]

Treatment options for type IIA fractures include both conservative and surgical measures. Conservative treatment consists of closed reduction that is obtained under fluoroscopic guidance via application of compression and extension and is followed by halo-vest immobilization. Repeated imaging is used to monitor the healing process with a variable time course. Surgical options include C2 transpedicular screws and anterior cervical plating. Conservative and surgical treatments typically yield very good results. Malunion is a potential complication.

For type III fractures, surgery is indicated if the fracture line extends anteriorly to the facet dislocation, at the level of the dislocation, or just posterior to it. Any of these locations make reduction unlikely secondary to instability. In this case, surgical reduction and stabilization is mandated and is accomplished with lateral mass plates, interspinous wiring, or bilateral oblique wiring. Once accomplished, bilateral pedicle fractures can be addressed with C2 transpedicular screws, or treated conservatively with traction or a halo/vest. Lateral mass plating of C2 by placing lateral mass screws in C3 in conjunction with C2 transpedicular screws may make postoperative halo immobilization unnecessary.

Atypical traumatic spondylolisthesis fractures are managed on a case-by-case basis, weighing the need for more aggressive stabilization against the likelihood of fragment dislodgment and subsequent spinal cord injury. Surgical treatment options for these fractures include C2 transpedicular screw fixation along with odontoid screw fixation.

For all types of traumatic spondylolisthesis fractures, nonunion and malunion are the major complications of nonoperative treatment, but, fortunately, these are rare occurrences.

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