Definition
- Traumatic spondylolisthesis of C2 with fractures through both pedicles or pars
- Hangman type injury
Epidemiology
- Infrequent in children
- Child abuse should be considered in infants
Aetiology
- Hyperextension with axial load
Clinical Features
- Neck pain and reluctance to move the head
- Neurology is often intact as the canal widens
Investigations
- Lateral cervical radiograph
- CT shows the pedicle fractures
- MRI for ligament and disc injury
Differential Diagnosis
- Physiological pseudosubluxation of C2 on C3 in young children
- Swischuk posterior cervical line helps separate the two
- Persistent neurocentral synchondrosis can mimic a fracture
Classification
Levine and Edwards (adult)
| Type | Description |
|---|---|
| I | Under 3 mm displacement, no angulation |
| II | Displacement and angulation |
| IIa | Angulation without translation, distraction makes it worse |
| III | With facet dislocation |
Original publication Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am. 1985;67(2):217-26.
Management
- Reduction by gentle positioning
- Immobilise in a Minerva cast or halo
- Do not use traction
- Fusion for persistent instability or failed nonoperative treatment
Complications
- Nonunion
- Persistent instability
- Pin site problems with halo in thin paediatric skulls
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.