Spinal fracture classification

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The information below is contained in papers found in the literature search carried out to inform this clinical decision making tool.

View C1 - C4 Pathway

Odontoid Peg Fracture Classification / D’Alonso & Anderson classification

Type I

  • rare
  • fracture of the upper part of the odontoid peg
  • above the level of the transverse band of the cruciform ligament
  • usually considered stable

Type II

  • most common
  • fracture at the base of the odontoid peg
  • below the level of the transverse band of the cruciform ligament
  • unstable
  • high risk of non-union

Type III

  • through the odontoid peg and into the lateral masses of C2
  • relatively stable if not excessively displaced
  • best prognosis for healing because of the larger surface area of the fracture

Hangman/Pedicle Fracture Classification

Levine and Edwards classification is used to classify Hangman Fractures of C2 (also known as traumatic spondylolisthesis of axis).

Type I

  • fracture with <3 mm antero-posterior deviation
  • no angular deviation

Type II

  • fracture with >3 mm antero-posterior deviation
  • significant angular deviation
  • disruption of posterior longitudinal ligament

Type IIa

  • the fracture line is horizontal/oblique (instead of vertical)
  • significant angular deviation without anterior translation

Type III

  • type I with bilateral facet joint dislocation

Guidelines

National Institute of Health and Care Excellence (NICE). Spinal injury guideline: assessment and initial management. NG41. 2016

Editorial Information

Last reviewed: 02/04/2024

Next review date: 01/05/2026

Reviewer name(s): Aimie Holland, Susie Hughes, Nikki Munro.