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Traumatic spondylolisthesis II of the cervical vertebra: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Traumatic spondylolisthesis II of the cervical vertebra, or the so-called "fracture of the executioner" - a kind of fracture of the axis, at which a fracture of the roots of its arch, a rupture of the intervertebral disk located between the II-III cervical vertebrae, and slipping of the axis body with all the structures above it anteriorly .
The line of damage goes at a right angle - vertically through the symmetrical parts of the roots of the arches of the 2nd cervical vertebra, then turns at a right angle horizontally and continues anteriorly through the intervertebral disk between the II-III cervical vertebral bodies. There is a complete separation of the body of the axis from its half-bows and the body of the underlying vertebra. The body of the axis, which is not held together with the atlant and the skull, is shifted anteriorly. The bow of the axis remains in place. Due to the displacement of the axial body anteriorly and the absence of displacement of the posterior elements of the cervical vertebra II, there is an increase in the anterior-posterior diameter of the vertebral canal at this level, which is why there is no mechanical compression or damage to the spinal cord. However, if there is an excessive displacement of the cervical vertebra's body II anteriorly, then a "cut" or compression of the spinal cord may be caused by the posterior arch of the atlas shifted toward the front.
Causes of traumatic spondylolisthesis II of the cervical vertebra
Usually, these injuries occur when you fall on your head or pile on your head with heavy weights, provided that the head is in an extensional position. Trauma to the head usually leads to the occurrence of concomitant severe brain damage. Possible concussions and bruises of the spinal cord and bulbar parts of the brain. Neurological symptoms occurring during these injuries are explained by the above mentioned brain injuries, as well as extramedullary and intramedullary hemorrhages, brain edema. Clinical manifestations of brain injury are very diverse and depend on the localization, extent and nature of the changes that have occurred under the influence of trauma.
[Symptoms of traumatic spondylolisthesis II of the cervical vertebra
The general condition of such victims, delivered from the scene, can be extremely difficult. The common cerebral symptoms, excitement, loss of consciousness, various kinds of motor disorders and prolapses predominate .
Locally, abrasions and bruises, hemorrhages in the head and forehead, swelling and pastness in the posterior parts of the neck are determined. If the patient is unconscious or in a state of excitement, then it is not possible to identify and reveal the presence and localization of pain, the possible volume of movements, the degree of their soreness. The nature of the violence that caused the damage can lead to a concomitant fracture of the bones of the cranial vault, the detection of which can distract the doctor's attention from the existing damage to the spine and explain all observed clinical symptoms by damage to the skull and its contents. Along with this, it is possible to view the concomitant damage to the skull.
Diagnosis of traumatic spondylolisthesis II of the cervical vertebra
X-ray examination allows you to establish the correct diagnosis. The decisive is the profile spondylogram, which is characterized by rather characteristic features - the separation of the arch of the axis in the region of its roots and the displacement of the axis body anteriorly, the body of the axis step-wise stands anterior to the third cervical vertebra.
The damage to the intervertebral disk between the II-III cervical vertebral bodies is also determined.
Treatment of traumatic spondylolisthesis II cervical vertebra
From the moment the doctor communicates with the victim, the most thorough immobilization of the head and neck is required, most reliably carried out by the assistant's hands. Particular care should be taken when transferring the injured person, X-ray examination. In the presence of indications, a spinal puncture is performed with liquorodynamic assays and a study of the cerebrospinal fluid for the presence of blood. According to the indications, symptomatic medication is performed. In the absence of indications for revision of the contents of the spinal canal and active intervention for possible concomitant damage to the bones of the skull, skeletal traction is applied for the bones of the cranial vault with a load of 4-6 kg. The stretching is carried out on a horizontal plane. The correction of the fracture, confirmed by the control spondylogram, is an indication for the imposition of the craniotoracic bandage for 4-6 months. Subsequent clinical and radiological examination of the patient solves the issue of the expediency and necessity of further external immobilization with plaster or removable orthopedic corset.
The inability to correlate fragments of a fractured vertebra with fresh injuries in its correct position or subsequent instability in the area of a former lesion, as well as a tendency toward progressive deformation of the spine, is an indication for the implementation of an occipospondylodease or anterior spondylodease.