Is it feasible to treat unstable traumatic spondylolisthesis of the axis via posterior fixation without fusion?

Abstract

Background Few studies reported treatment of unstable traumatic spondylolisthesis of the axis using posterior fixation without fusion. The aim of this study was to evaluate the results and feasibility of posterior fixation without fusion in treating unstable traumatic spondylolisthesis of the axis. Methods Eleven patients with traumatic spondylolisthesis of the axis were included in this study, and posterior fixation without fusion using screw-rod system was performed for them. The clinical outcomes were assessed using the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the Odom’s grading system. Plain radiography was used to measure the displacement and angulation of C2-C3, and cervical lordosis. Plain radiography and computed tomography were also used to observe the bony fusions of fracture lines and postoperative spontaneous fusion of C2-C3. Results The mean follow up time was 24.6 months (range, 12–72 months). The VAS and NDI scores were significantly improved at the final follow-up compared with those before operation (P < 0.05), and according to Odom’s criteria, 90.9% (10/11) of patients rated their level of satisfaction as excellent or good. The angulation and displacement of C2-C3, and cervical lordosis were significantly improved after operation compared with those before operation (P < 0.05), and at the final follow-up, and these radiological parameters were maintained. All patients achieved solid bony fusions of fracture lines. No operative segment instability was found in all patients during the follow-up period. Spontaneous fusion at bilateral C2-C3 facet joints was found in 11 cases, and anterior and/or posterior bony bridge of intervertebral bodies at C2-C3 was found in 9 cases. Conclusions Posterior fixation without fusion may be a feasible and effective option for unstable traumatic spondylolisthesis of the axis.

Fijación con tornillo transpedicular en C2 en el tratamiento de fractura de Hangman tipo III de Levine-Edwards: una opción para preservar el movimiento

“…It is widely accepted that type II, IIa and III fractures are unstable and must be treated surgically. 9 Hangman's type III fractures should be diagnosed and treated promptly due to the risk of neurological injury. In 1964, Leconte 10 described direct C2 transpedicular fixation for the Hangman's fracture, demonstrating its effectiveness.…”

“…2 The surgical objectives, in addition to the reduction, stabilization and maintenance of the alignment of the cervical spine, should be the preservation of the range of motion. 9,11 Different surgical approaches, both anterior and posterior, have been described for the treatment of Hangman's type III fracture. 2,5,9,11 An anterior approach has the advantage of a technically simple and relatively short fusion involving a C2-C3 discectomy with interbody fusion and plating.…”

“…9,11 Different surgical approaches, both anterior and posterior, have been described for the treatment of Hangman's type III fracture. 2,5,9,11 An anterior approach has the advantage of a technically simple and relatively short fusion involving a C2-C3 discectomy with interbody fusion and plating. 12 However, the anterior approach cannot address the detached posterior arch of C2 and may have approach-related problems.…”

“…However, both discectomy and ACDF and posterior fixation with C1-C2 screws will lose mobility of the fused segment. 2,9 Direct repair of the pars interarticularis fracture with a transpedicular screw across the fracture line has the advantage of preserve segment motion. 2,13 However, traditional transpedicular screw fixation for Hangman fracture has several disadvantages.…”

“…The healing rate of Hangman type III fractures treated by C2 transpedicular fixation is high (89.29%). 9,13…”