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Nontraumatic Spondylolisthesis of the Axis with Cervical Kyphosis.

ABSTRACT: This study aimed at presenting a rare nontraumatic spondylolisthesis of the axis and considering its possible cause. Traumatic spondylolisthesis of the axis, called hangman's fracture, frequently occurs as a high-energy trauma. However, nontraumatic spondylolisthesis of the axis is quite rare, and relevant literature on this condition is scarce. We reported a case of a 49-year-old man who had spondylolisthesis of the axis without experiencing a traumatic episode. Plain radiograph and CT image showed 7.0?mm anterolisthesis of the axis. Both C2 and C3 facet joints positioned asymmetrically, and the unilateral side oriented coronally, which was less resistant to rotational motion. These facet joint abnormalities could cause segmental instability and spondylolisthesis of the axis. Due to the resultant myelopathy, the slip with cord compression was surgically corrected by posterior decompression with instrumented fusion.

SUBMITTER: Mizobuchi S

PROVIDER: S-EPMC7106903 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Nontraumatic Spondylolisthesis of the Axis with Cervical Kyphosis.

Mizobuchi Shuhei S Tadokoro Nobuaki N Takaya Shogo S Kiyasu Katsuhito K Takemasa Ryuichi R Ikeuchi Masahiko M

Case reports in orthopedics 20200319

This study aimed at presenting a rare nontraumatic spondylolisthesis of the axis and considering its possible cause. Traumatic spondylolisthesis of the axis, called hangman's fracture, frequently occurs as a high-energy trauma. However, nontraumatic spondylolisthesis of the axis is quite rare, and relevant literature on this condition is scarce. We reported a case of a 49-year-old man who had spondylolisthesis of the axis without experiencing a traumatic episode. Plain radiograph and CT image sh ...[more]

PMID: 32257484

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Project description:BackgroundAdult spinal deformity, especially sagittal imbalance, is affecting health-related quality-of-life (HRQOL) scores. There is a lack of emphasis in the comparison of cervical sagittal parameters in patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis. The aim of study is to determine the preoperative and postoperative cervical sagittal parameters in myeloradiculopathic patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis treated by anterior cervical discectomy and fusion (ACDF).MethodsA retrospective medical records and radiographic study of 30 adult patients were reviewed. Fifteen patients with degenerative cervical spondylolisthesis and 15 patients with degenerative cervical kyphosis have been performed ACDF from 2010-2020. We measured the preoperative and postoperative cervical sagittal parameters: C0-C2 angle, C1-C2 angle, C2-C7 angle, C2-C7 sagittal vertical axis (SVA), T1 slope, neck tilt angle and thoracic inlet angle. Minimum follow-up period was at least 2 years.ResultsPatients in degenerative cervical kyphosis group have C2-C7 angle less than degenerative cervical spondylolisthesis group (-14.88±7.32 vs. 9.60±13.60), leading to increase the mismatch between T1 slope and C2-C7 angle in kyphotic group and hyperlordosis of C0-C2 angle and C1-C2 angle (31.13±7.68, 37.88±5.08) compare with spondylolisthesis group (13±10.20, 24.60±10.70). Whereas patients with degenerative cervical spondylolisthesis have C2-C7 SVA (33.22±13.92) more than kyphosis group (13.70±13.60). After surgery, there is significant increase of the C2-C7 angle in the kyphosis group compare before and after surgery (-14.88±7.32 vs. 4.10±11.80). While the spondylolisthesis group has no significantly different parameters compare to before surgery. However, the postoperative cervical sagittal parameters of all patients are within the normal thresholds (T1-Slope minus C2-C7 lordosis <15° and C2-C7 SVA <40 mm).ConclusionsThe study demonstrates the difference of sagittal parameters between degenerative cervical spondylolisthesis and kyphosis before and after surgery. ACDF not only provides neural decompressive procedure, but also corrects the regional cervical sagittal parameters.

Project description:Study Design Narrative review. Objective To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis. Methods Literature review using PubMed, Google Scholar, and Cochrane databases. Results The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2-C3 disk is essential. Although its synonym "hangman's fracture" suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2-C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2-C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2-C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2-C3 disk, which is usually regarded as stable and therefore might be treated conservatively. Conclusions Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations.

Project description:Favorable bone fusion and clinical results have been reported for anterior cervical fusion (ACF) using titanium interbody cage (TIC). This method might induce postoperative subsidence and local kyphosis, but the relationship between radiological changes and preoperative local alignment is not known. The purpose of the present study is to investigate the impact of preoperative local alignment on the clinical and radiological outcomes of ACF using TIC.The study enrolled 36 patients (mean age 49.8 years) who underwent single-level ACF using TIC for cervical degenerative diseases. Patients were divided into 2 groups by preoperative segmental lordotic angle at the operative level: group L, ≥0° (n = 16); group K, <0° (n = 20). Clinical outcomes included recovery rate according to the Japanese Orthopaedic Association score and complication rates. Radiological assessment was conducted for the cervical and segmental lordotic angles, subsidence, and bone fusion. Mann-Whitney test and chi-square test were applied to compare the outcomes.The Japanese Orthopaedic Association score recovery rate was 77.2% in group L and 87.6% in group K, with no significant difference. No obvious complications were observed in any of the subjects. Mean cervical lordotic angles preoperatively and at last follow-up were 9.2 ± 9.5° and 11.3 ± 11.7°, respectively, in group L, and -1.3 ± 12.8° and 4.6 ± 13.3°, respectively, in group K. The mean segmental lordotic angles preoperatively and at last follow-up were 2.5 ± 2.2° and 2.6 ± 5.7°, respectively, in group L, and -4.5 ± 2.8° and -1.4 ± 5.8°, respectively, in group K. In group K, the cervical and segmental lordotic angles at the last follow-up were significantly greater than the preoperative angles. The change observed in group L was not significant. Subsidence of ≥3 mm was observed in 3 patients in group L and 4 patients in group K. None of the patients showed nonunion.Anterior cervical fusion using TIC provided favorable clinical results regardless of preoperative segmental alignment. Although postoperative subsidence and kyphotic changes are concerns in patients presenting segmental kyphosis, ACF using TIC corrected both the entire cervical spine and segmental alignment. The TIC is useful for correction of the cervical alignment for patients with cervical degenerative disease with local kyphotic changes.

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Nontraumatic Spondylolisthesis of the Axis with Cervical Kyphosis.

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Nontraumatic Spondylolisthesis of the Axis with Cervical Kyphosis.

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