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Traumatic spondylolisthesis of the II cervical vertebra: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Traumatic spondylolisthesis of the second cervical vertebra, or the so-called "hangman's fracture" is a peculiar fracture of the axis, in which there is a fracture of the roots of its arches, a rupture of the intervertebral disc located between the bodies of the second and third cervical vertebrae, and slippage of the axis body with all the formations located above it forward.
The line of injury runs at a right angle - vertically through the symmetrical sections of the roots of the arches of the second cervical vertebra, then turns horizontally at a right angle and continues forward through the intervertebral disc between the bodies of the second and third cervical vertebrae. There is a complete separation of the axis body from its semi-arches and the body of the underlying vertebra. The axis body, which is not held in place by anything, shifts forward together with the atlas and skull. The axis arch remains in place. Due to the forward displacement of the axis body and the absence of displacement of the posterior elements of the second cervical vertebra, there is an increase in the anterior-posterior diameter of the spinal canal at this level, which is why there is no mechanical compression or damage to the spinal cord. However, if there is an excessive forward displacement of the body of the second cervical vertebra, then "cutting" or compression of the spinal cord by the posterior arch of the atlas shifted forward may occur.
Causes of traumatic spondylolisthesis of the second cervical vertebra
These injuries usually occur when a person falls on the head or when heavy objects fall on the head while the head is in an extension position. Head trauma usually results in concomitant severe brain damage. Concussions and contusions of the spinal cord and bulbar region of the brain are possible. The neurological symptoms that occur with these injuries are explained by the above-mentioned brain damage, as well as extramedullary and intramedullary hemorrhages and cerebral edema. The clinical manifestations of brain trauma are very diverse and depend on the location, degree and nature of the changes that have arisen under the influence of the trauma.
[ Symptoms of traumatic spondylolisthesis of the second cervical vertebra
The general condition of such victims, delivered from the scene of the incident, can be extremely serious. General cerebral symptoms, agitation, loss of consciousness, various types of movement disorders and loss of consciousness predominate.
Locally, abrasions and bruises, hemorrhages in the crown and forehead, swelling and pastosity in the back of the neck are determined. If the patient is unconscious or in a state of excitement, it is impossible to determine and identify the presence and localization of pain, the possible range of motion, the degree of their pain. The nature of the violence that caused the injury can lead to an accompanying fracture of the bones of the cranial vault, the detection of which can distract the doctor's attention from the existing injury to the spine and explain all the observed clinical symptoms by damage to the skull and its contents. Along with this, it is possible to view the accompanying injuries to the skull.
Diagnosis of traumatic spondylolisthesis of the second cervical vertebra
X-ray examination allows to establish the correct diagnosis. The decisive factor is the profile spondylogram, which determines quite characteristic signs - separation of the axis arch in the area of its roots and displacement of the axis body forward, the axis body stands stepwise forward over the body of the third cervical vertebra.
Damage to the intervertebral disc between the bodies of the II-III cervical vertebrae is also determined.
Treatment of traumatic spondylolisthesis of the second cervical vertebra
From the moment the doctor communicates with the victim, the most careful immobilization of the head and neck is required, most reliably carried out by the hands of an assistant. Particular care should be taken when moving the victim and performing an X-ray examination. If indicated, a spinal puncture with cerebrospinal fluid dynamics tests and examination of the cerebrospinal fluid for the presence of blood is performed. Symptomatic drug treatment is performed according to indications. In the absence of indications for revision of the contents of the spinal canal and active intervention for possible concomitant injuries to the bones of the skull, skeletal traction is applied to the bones of the cranial vault with a load of 4-6 kg. Traction is performed along the horizontal plane. Reduction of the fracture, confirmed by a control spondylogram, is an indication for the application of a craniothoracic bandage for 4-6 months. Subsequent clinical and X-ray examination of the patient resolves the issue of the advisability and necessity of further external immobilization with a plaster cast or removable orthopedic corset.
The inability to align the fragments of a broken vertebra in the desired position in the case of fresh injuries or subsequent instability in the area of the former injury, as well as the tendency towards progressive deformation of the spine are indications for the implementation of occipitospondylodesis or anterior spondylodesis.