Traumatic spondylolisthesis of the axis: Analysis of treatment and outcome in 40 cases

Abstract

The current treatment of traumatic spondylolisthesis of the axis (TSA) is widely variable and management options include conservative options and surgical procedures. Unfortunately, the literature has several heterogeneous classification schemes, stability criteria and treatment algorithms thus making it difficult to derive clinical practice guidelines. This study seeks to identify predictors of successful outcome with conservative management. This retrospective study presents a consecutive series of 40 patients with TSA. Statistical analysis was performed to correlate clinical and radiographic measures with nonunion, residual neck pain and range of motion at final follow-up. Statistical analysis reveals Francis grade V having a significant correlation with non-union. Logistic regression analysis indicates that age (p=0.0107), initial translation (p=0.0189) and chronic tobacco use (p=0.0104) are significant risk factors for non-union in patients primarily treated with conservative management. Chronic tobacco use is the strongest predictor of non-union with an odds ratio of 65.99 (95% CI 2.39-21123.13). Initial translation was associated with an odds ratio of 1.62 (95% CI =1.08-3.15) and age had an odds ratio (per year) of 1.13 (95% CI = 1.02-1.39). The majority of TSA managed with conservative treatment achieved a satisfactory outcome, while early surgical fusion could be considered when risk factors exists.

Keywords: axis fracture, traumatic spondylolisthesis, classification, treatment