Spondylolisthesis

JOHN

The only

known

condition

JR.,

SALUTARIO
MARTINEZ,
WILLIAM
M. CLARK,
AND GRADY
C. STEWART.
JR.
spondylolysis
lamina

of

mans fracture)
is true spondylolisthesis
of the axis vertebra. Spondylolisthesis
of cervical
vertebrae
is extremely
rare, and all published
cases involve
the lower
cervical
spine [1-171.
This case is the only one, to our knowledge,

defect

passes

vertebra.

The

involving

analagous

to

the

must

Vertebra

in the

diagnosis

that

Axis

(hang-

differential

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A. GEHWEILER.

of the

of traumatic

be considered

spondylolisthesis

the

axis.

is a defect
a vertebra,

axis

vertebra.

Anatomy
The

second

guished
upper

cervical

from
end

all others

of the

body,

or

axis,

by a toothlike
the

dens

is readily

projection

(fig.

from

1 ). Anteriorly

the

the

of fracture
fracture

dens

has a facet for articulation

with the corresponding
facet
on the innermost
surface
of the anterior
arch of the atlas.
Posteriorly
the neck of the dens is grooved
by the transverse

ligament

broad

and strong,

articular

of

The

pedicles

of the

and are partially

the

covered

by the superior

surfaces.

atlas.

Strong

thick

laminae

with a broad, short, bifid spinous

process
ends in a single tubercle
verse foramen

slightly

convex

directed

faces

which

superior

anticular

body

which

has

typical

and

an

pedicle.

anticular

cervical

in the

lumbar

facet,

region

process

Articular
anterior

extends

The
The

the

region
rest

of

to

not

are
the

white
for

to the

Examination
there

of

the

have

an

or both

sides,

and

pedicIes
cervical

the
of

axis

is

a lumbar

must

be a bony

passing

between

ramainder
of
this to be the

the
site

so-called
hangmans
the vertebral
arch

of the axis (fig.

in some

2). The transverse

cases.

superior
defines

(A) and

above

evaluation

head

minimal

or neck.

was

referred

of neck

pain.

For

on

the

the

a full

neck

to Duke
There

3 years

was

of the

a block
left,

and

the

University

was

patient

no history
had

expeni-

partial

articular

of

spine

neck,
of

defects

multiple

an absent

assimilation
surfaces

in the

extremes

showed

at C5-C6.

bony

motion

at the

but

motion.

normal.

cervical

vertebra

bilateral

superior

range

discomfort

examination

Radiographs

corticated,

He

Report

woman

revealed

was

Neurologic

1191

the

lamina

of

process

hangings.
In the
spondylolisthesis),

the body

the

atypical

a spondylolysis

on one

The

enced neck pain lasting from 1 to 3 days, followed

by remissions
lasting
several
months.
On a few occasions
she experienced
numbness
in the left upper limb.

including

between

an

surface

articular

be fractured

Center

of trauma

191.

the

is

of the
sides.

process
to

anticulan
surface
and the
1). Wood-Jones
[20] found

may

Medical

oval,

by Hollingshead

spine

axis,

both

it is caudal

Case

process,

those

does

in the

continuity
or

articular

articular

superior

lamina

A 34-year-old

from

articular

axis

mass
118,
is defined

as the

and

inferior

the

one

superior

cervical

superior

bony

on

are

of the axis
laterally

is similar

vertebrae.

articular
pillar or a lateral
The pars interarticulanis
articular

surfaces

Each

large,

the

from

process

posteriorly

The

lamina;

in judicial
(traumatic

is avulsed

process.
Each transverse
and is pierced
by a trans-

superolaterally.

superolaterally.

vertebral

fuse

axis

in the

the superior
lamina
(fig.

distin-

of the

Thus

defect

vertebra,

the

of

D. MILLER,

in the

either

between

remainder
The

MICHAEL

of
through

of the

axis

the

atlas
the

and

anomalies,

pedicle
(fig.

laminae
the

inferior

3).

at C6
Well

between
artic-

face

arch

of

Fig.

Received
All

1 -Axis

October

authors

13.

Department

vertebra

1976;

viewed

accepted
of

to J A. Gehweiler.

Jr

Am J Roentgenol

128:682-684,

Radiology.

April

from

after
Duke

1977

side

revision

January

University

7.
Medical

and

behind

Center.

P.O

(B) showing

region

of

pars

interarticularis

(arrows).

1977

682

Box

3808.

Durham,

North

Carolina

27710

Address

reprint

requests

ular processes
were also shown.
The axis body was displaced
ventrally
on C3 a few millimeters
(fig. 4A). The pars interarticularis
defects were also clearly observed
on the 45#{176}
oblique
radiographs
(figs. 48 and 4C).

Discussion

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There

are

in the

1 9 reported

world

characteristic

cases

involved

had

neunologic
on

from

spine

of trauma,
and nuchal

torticollis,
rigidity.

Most

at the

of the

level

Fig.

2.-Traumatic

spondylolisthesis

of

3.-Lateral

vertebra.

Note

jagged

(A) and left

case

at C4,

a female;

years.

defect

edges

The

etiology

of the
than
4).

bony

smooth,

defects
some

It remains

unclear

dysphagia,
spina
bifida

have

studies

clearly

been
shown

this

those
of
How-

of trauma
defined

is unknown.
not

have

whether

resemble
fracture).

in cases

with

of spondylolisthesis

newborns,

ob-

episodes

spondylolisthesis.

ever,

rather
(fig.

patients
were

neck
pain.
brachialgia,
of the cases showed
in this case
(hangmans

the

the

following

The radiographic
changes
traumatic
spondylolisthesis
jagged
margins

of

abnormalities

nadiographs

the

all other

the ages of the

None

The

showed
while

found

While

pans

in stillborns

a familial

condition

are

cortical

or

incidence.
is

congenital

on acquired.

sites.

K4
Fig.

axis

58

findings.

cervical

interarticulanis

edges at fracture

changes

8 to

spondylolisthesis

One

C6. One case was

ranged

any

of cervical

[1-171.

radiographic

patients
served

cases

literature

anterior

oblique

(B) views

showing

block

vertebra

at C5-C6.

absent

pedicle

on left at C6. and dysplasic

articular

pillar

CASE

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684

Fig. 4-Spondytotisthesis
showing

margins

of pars

of axis
interarticularis

A. Lateral
defects

view showing
(arrows).

pars

REPORTS

interarticularis

REFERENCES
1 . Azouz EM, Chan JD, Wee A: Spondylolysis
of the cervical
vertebrae.
Report of three cases. with a review of the English
and French
literature.
Radiology
111 :315-318,
1974
2. Bellamy
A, Lieber A. Smith SD: Congenital
spondylotisthesis
of the sixth cervical
vertebra.
Case report and description
of
operative
findings.
J Bone
Joint
Surg
[Am]
56:405-407,
1974
3. Bdhler J: Fehldeutung
einer zervikalen
Spondylilisthese
ats
Luxationsfraktur.
Z Orthop
104 :609-61
2. 1968
4. Bozdech
Z: Spondylolisthese
der Halswirbelsdule.
Beitr
Orthop Traumatol 14:158-161,
1967
5. Csakany
G, Almos
S: Echte
Spondytolisthese
der Halswirbels#{228}ule (C6
Symptomenkomptex).
Fortschr
Geb
Roentgenstr
Nuklearmed
91:277-280,
1959
6. Dawley JA: Spondylolisthesis
of the cervical
spine.
J Neurosurg 34:99-101.
1971
7. Durbin
FC: Spondylolisthesis
of the cervical
spine. J Bone
Joint Surg [Br] 38:734-735.
1956
8. Henkel
U: Spondylolisthese
der Halswirbelsdule.
Z Orthop
101 :549-559.
1966
9. Isobe Y: Two cases of spondylolysis
of the cervical
disk.
Orthop Surg (Tokyo)
17:285-289,
1966
10. Kau A: Spondylolisthese
der Halswirbels#{226}ule. Arch
Orthop
Unfallchir
46:502-507,
1954

defect

and well

corticated

bony

1 1 . Klaus E: Em fall von echter

der

Hatswirbelsule.

margins.

B and C. 45#{176}oblique

Spondylolthese

Fortsch

Geb

views

mit Spondylotyse

Roentgenstr

Nuklearmeo

110:277-279,
1969
1 2. Lissner
J: Spondylolisthese
der Halswirbelsaule.
Fortschr
Geb Roentgenstr
Nuklearmed
84:626-628,
1956
13. Moseley
I: Neural arch dysplasia
of the sixth cervical
vertebra.
Congenital
cervical
spondylolisthesis
Br J Radiol
49:81-83,
1976
14.

Niemeyer

TH,

Penning

L:

Functional

examination
in a case of cervical
Joint Surg [Am] 45:1671-1678,
15. Perlman
A, Hawes
LE: Cervical
Joint
Surg
[Am]
33:1012-1013.
16. Schkter
K:
Uber
Spondylolisthese
Med
KIm 51:1018-1020,
1956
17.
18.
19.

Wiedhopf

H:

Beitr

Orthop

Gray

H:

Goss

CM,

Uber

Anatomy

Hollingshead

die

Traumatol
of

Philadelphia,
H:

The

der

Human
Lea

vol

back

Bone

im

Halsbereich.

1965

29th ed, edited

1973

Body,

& Febinger.
and

HalswirbelsuIe.

Spondylolisthese
12:694-697,

the

J Bone

1951

limbs,

3. 2d ed, New York, Harper

85-88.
137-138
20. Wood-Jones
F: The ideal lesion produced
Lancet
1:53, 1913
geons.

roentgenographic

spondytolisthesis.
1963
spondylolisthesis.

in

Anatomy

for

& Row,

1969,

by judicial

by
Sur-

hanging.

pp