Levine and Edwards classification

Last revised by Joshua Yap on 28 Sep 2022

Citation, DOI, disclosures and article data

Citation:

Goel A, Yap J, Jones J, et al. Levine and Edwards classification. Reference article, Radiopaedia.org (Accessed on 25 Apr 2024) https://doi.org/10.53347/rID-35440

DOI:

https://doi.org/10.53347/rID-35440

Permalink:

https://radiopaedia.org/articles/35440

rID:

35440

Article created:

6 Apr 2015, Ayush Goel ◉

Disclosures:

At the time the article was created Ayush Goel had no recorded disclosures.

View Ayush Goel's current disclosures

Last revised:

28 Sep 2022, Joshua Yap ◉ ◈

Disclosures:

At the time the article was last revised Joshua Yap had no financial relationships to ineligible companies to disclose.

View Joshua Yap's current disclosures

Revisions:

11 times, by 6 contributors - see full revision history and disclosures

Systems:

Musculoskeletal, Spine, Trauma

Sections:

Classifications

Tags:

refs, spine, cases

The Levine and Edwards classification is the most widely used classification system of hangman fractures of the C2 vertebra ³. The injury, also known as traumatic spondylolisthesis of the axis, and the amount and direction of displacement determines stability and guides treatment. The classification system is a modified version of the original scheme described by Effendi ⁴.

Classification

type I: minimally displaced fracture with ≤3 mm antero-posterior translation
- no angulation
- C2/3 disc intact therefore no disc space widening
- due to a hyperextension and axial loading mechanism
- associated with atlas fractures, specifically Jefferson, odontoid process and posterior arch fractures
- stable injury
- treatment is collar immobilisation
type II: displaced fracture with >3 mm antero-posterior translation
- angulation of ≤10^o
- vertical fracture line
- the C2/3 disc and posterior longitudinal ligament are disrupted
- due to a distractive flexion or compressive hyperextension mechanism
- associated with C3 anterosuperior compression fractures and C2 endplate avulsion fractures
- unstable injury
- treatment depends on the degree of displacement and is either with halo immobilisation or surgery
type IIa: type II fracture with minimal or no translation but marked angulation
- angulation of >10^o
- horizontal/oblique fracture line
- significant angular deviation without anterior translation
- anterior longitudinal ligament is intact
- due to a similar mechanism as type II injuries
- unstable injury
- treatment is with a compression halo but traction needs to be avoided (as it increases fracture angulation)
type III: type II fracture with bilateral facet joint dislocation
- rare
- due to a distractive flexion mechanism
- treatment is surgery

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