ABSTRACT
OBJECTIVES: To evaluate the surgical indications and to compare the results of the anterior plate fixation and transpedicular fixation in cases of traumatic spondylolisthesis of the axis. MATERIALS AND METHODS: From 1987 to 2001, eighteen of 26 cases of traumatic spondylolisthesis of the axis were treated by anterior plate fixation and 8 of 26 by transpedicular screw fixation. Two of 8 cases received unilateral screw fixation and 6bilateral fixation. Two cases of the transpedicular screw fixation group were treated by additional posterior plate fixation. Oper-ativeindication was an unstable fracture, namely, with over 3.5 mm of anterior displacement, over 10 degrees of angulation, i.e., Levine types II, IIA, III, and IA. Postoperatively, Philadelphia orthosis or a soft collar was applied for 6 to 8 weeks. RESULTS: All cases achieved bone union. One case of neck pain, three cases of neck motion limitation and three cases of a kyphotic deformity exceeding 10degrees were observed in the posterior transpedicular screw fixation group. In terms of surgical complications, two cases of transient dysphagia were observed in the anterior plate fixation group and two cases of screw malposition in the transpedicular screw fixation group. The transpedicular screw fixation technique has some associated problems, such as a large operative wound scar, a large bleeding volume, and technical difficulty. CONCLUSION: Both the anterior plate fixation and transpedicular screw fixation methods are useful treatment methods for Levine type II, IIA and III hangman fracture for early bone union and early rehabilitation. The anterior plate fixation technique is easi-er and has fewer complications than posterior transpedicular screw fixation, therefore, the ranspedicular screw fixation method should be confined to the management of type IA fracture with rotational displacement.
