Skip to Main Content

++ ++

  • 738.4 Acquired spondylolisthesis
  • 756.12 Spondylolisthesis congenital
  • 805.02 Closed fracture of second cervical vertebra

++

  • M43.10 Spondylolisthesis, site unspecified
  • Q76.2 Congenital spondylolisthesis
  • S12.100A Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
  • S12.101A Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture

++
++

Description

++

  • Anterior (forward) translation of a vertebra
  • C2 vertebra anterior translated on C3 with fracture of C2 pedicles
  • Fracture of the pedicles on C2 vertebra
  • Slipping of vertebra in relationship to the vertebra below
  • Neurogenic claudication
  • Fracture widens at the pars

++

Essentials of Diagnosis

++

  • Diagnosis made by x-ray
  • Clinical examination may find step deformity
  • Dermatome/myotome pattern
  • Stability of cervical spine is critical
  • Spondylolysis: fracture without displacement

++

General Considerations

++

  • Instability
  • Individual may not know they have a fracture immediately following an accident
  • Avoid extension positions that increase symptoms

++

Demographics

++

  • After trauma
  • Suicidal hanging

++

Signs and Symptoms

++

  • Cervical, shoulder, arm, upper-extremity pain and paresthesia, often radiating into lower extremities if central cord involved
  • Constricted pupil (Horner’s sign)
  • Stiffness along spine
  • Headaches
  • Pain in cervical spine worsens with extension
  • Diminished sensation, motor control, reflexes in the distribution of involved nerve
  • Neurogenic claudication

++

Functional Implications

++

  • May cause death
  • Difficulty maintaining standing posture secondary to neck and arm pain
  • Inability to sleep flat on back without a pillow
  • Weakness with lifting
  • Loss of movement or feeling in the upper extremity
  • Difficulty with movements (reaching overhead) secondary to pain
  • Limited sports participation

++

Possible Contributing Causes

++

  • Forceful extension from hit under the chin (as in sports)
  • Congenital
  • Car accident, hit from rear
  • Hyperextension of the cervical spine

++

Differential Diagnosis

++

  • Peripheral-nerve impairment
  • Spinal tumor
  • Peripheral neuropathy
  • Paraspinal spasms
  • Degenerative disk disease
  • Stenosis

++

Imaging

++

  • MRI helps visualize compressed or inflamed nerve root in diagnosis
  • X-ray/plain-film radiograph to see vertebral position
  • CT to show herniation compressing the spinal canal/nerves
  • Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function

++

  • C2 vertebra anterior translated on C3 with fracture of C2 pedicles

++

  • To hospital for imaging
  • To surgeon for surgical consult if myelopathy suspected
  • To physician for corticosteroid injection
  • To physician for anti-inflammatory medication
  • To orthopedist for halo vest traction device, cervical bracing

++

  • Restricted mobility of upper cervical spine
  • Hypermobility
  • Noted weakness of neck musculature

++

  • Rest
  • Bracing
  • Address pain
    • Electrical stimulation
    • Heat/ice
  • Address hypertonicity
    • Soft tissue massage
    • Heat
  • Address muscle weakness
    • Stability exercises

++

  • Patient will be able to
    • Sit with neutral cervical-spine posture for greater than ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.