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2026, Number 2

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Cir Columna 2026; 4 (2)

Posterior C2-C3 cervical fusion in chronic traumatic spondylolisthesis of the axis. A case report and literature review

Jiménez ÁJM, Ramírez EJF, De CVO, Avilés SJ, Negrete IJ, Soria VA, Baez SG

Language: Spanish
References: 26
Page: 126-132
PDF size: 2182.52 Kb.


ABSTRACT

Traumatic spondylolisthesis of the axis, also known as "hangman's fracture" us an uncommon but clinically significant condition within the spectrum of cervical spine injuries. It is characterized by bilateral fractures of the C2 pedicles and anterior displacement of the vertebral body, which compromises the stability of the C2-C3 complex. Currently, its primary etiology is associated with high-energy trauma, particularly motor vehicle and motorcycle accidents. The case presented involves a 25 year old male patient, with no relevant medical history, who sustained a cervical spine injury after colliding with telephone wires while riding a motorcycle without protective gear, resulting in a hyperextension distraction mechanism al the cervical level. Initially, he was evaluated at a primary care hospital, where cervical wounds were sutured and plain radiographs showed no apparent bone injury; he was discharged with a rigid cervical collar and symptomatic management. However, 12 days after the trauma, he began experiencing progressive paresthesia in the left thoracic limb, prompting further clinical and radiological evaluation. A cervical CT scan revealed traumatic spondylolisthesis of C2-C3, leading to referral to a tertiary care hospital. Upon admission, 28 days post-injury, the patient presented with healing anterior neck wounds and partial sensory deficit. A surgical intervention was performed 43 after the trauma. A posterior approach was used, with open reduction, interfacetal fibrous tissue release, transpedicular fixation at C2 and transfacet screw fixation at C3, followed by rod placement under compression. This achieved satisfactory anatomic reduction and adequate stabilization of the cervical functional unit. The postoperative course was favorable, with progressive neurological recovery and resolution of dysesthesia ad the six month follow up. This case underscores the importance of timely diagnosis, as up to 20-57% off cervical spine injuries may go undetected on plain radiographs. CT is the imaging modality of choice, an MRI is essential to evaluated ligamentous or neural involvement. Moreover, proper surgical planning must be based on the time since injury, the reducibility of the lesion, the integrity of the articular facets, and the patient's neurological status. In chronic injuries such as this case, a posterior only approach may be sufficient if the facet joints can be freed and an effective surgical reduction achieved. Individualized management and timely surgical z.


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