(Figures 4 and and55) Figure 4 Minerva cast. Figure 5 Halo cast. The mean fracture healing time was 3.6 months. None of the patients underwent surgery. The existence of pseudarthrosis, neurological deficit or persistent cervicalgia at the end of the treatment was not reference 2 observed in any of the cases analyzed. The mean follow-up time was 9.6 months. However, it is worth mentioning that in most cases, there was loss of follow-up due to abandonment by the patient within the twelve months after fracture consolidation. None of the patients presented complications resulting from the treatment. (Table 1) Table 1 Summary of patients. DISCUSSION Traumatic spondylolisthesis of the axis, considered one of the most common forms of injury of the high cervical spine, is frequently addressed in an ambiguous manner with regard to its definition.

Some studies address fractures of the laminae, facets, body and/or pedicles as traumatic spondylolisthesis of the axis.1 However, more recent studies restrict the term to fractures of the C2 isthmus. This, in turn, was the approach adopted by the professionals involved in the present survey. Most authors affirm that the hangman fracture presents good prognosis.12,13 Our results corroborated this statistic. There was no need for surgical approach in any of the cases, and no progression of neurological deficit was observed. It is assumed that the absence of neurological lesion is a consequence of the decompression of the cervical canal resulting from this type of fracture.14,15 Thus, the incidence of neurological deficit is low, according to similar studies.

Among the analyzed cases, only one presented initial deficit, with total recovery in the follow-up period. The classification proposed by Effendi for this type of fracture suggests that subtype IIa requires differentiated treatment. However, although it is a fracture that is effectively different from type II, we did not observe relevant differences in the patients’ evolution, when we weighted the form of treatment and the healing time. This observation can also be verified in other studies.16 Considering the extremely low incidence of pseudarthrosis in traumatic spondylolisthesis of the axis, it is necessary to consider the possibility of offering a more comfortable form of treatment to the patient. At our Institute, the most common treatment used was the Minerva cast.

However, a less rigid form of Entinostat immobilization can be an equally safe and more comfortable option, in some cases.14,16,17 The fact that considerable importance is attached to the patient’s comfort is particularly relevant if we consider that, in the conservative treatment, immobilization will be used for a minimum period of 12 weeks. Satisfactory end results were observed in 100% of the patients. None of the patients analyzed presented unstable fracture, i.e., type III, confirming the rarity of this type of injury.