Levine and Edwards classification [Neurosurgery Wiki]

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=====Levine and Edwards classification=====
Levine and Edwards classification is used to classify [[Hangman's fracture]] of C2 (also known as traumatic spondylolithesis of [[axis]]).

====Classification====

{{::levinebueno.jpg?600|}}

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Levine Classification: (does not apply to children);

[[Levine and Edwards type 1]]

[[Levine and Edwards type 2]]

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Type III:
Includes all characteristics of type II frx as well as bilateral interfacetal dislocation; may require open reduction of facet dislocation halo immobilization for the pedicle injury; type III has angulation, translation, and also unilateral or bilateral facet dislocation at C2-3.

- Non Operative Rx:
Halovest

Pts w/ Hangman's fx should not be placed in cervical traction if mechanism of injury involves extension or distraction;

Children: traction should generally be avoided; reduction is obtained w/ gentle extension; some residual displacement may be accepted; need to immobilize in halo for 6-8 weeks;

Surgical Treatment:
ORIF may be necessary to obtain and maintain reduction; internal fixation techniques include posterior oblique wiring, which resists rotational forces, & screw fixation of C-2 posterior elements to the C-2 body.

This latter technique depends on integrity of C-2 & C-3 capsules and ligaments, which is usually the case.