Vertebral Artery Caught in the Fracture Gap after Traumatic C2/3 Spondylolisthesis

BACKGROUND CONTEXT Patient with a C2 fracture and entrapment of the right vertebral artery in the fracture gap. PURPOSE Presentation of a case with follow-up until end of treatment. STUDY DESIGN Case report. METHODS A 25-year-old woman was brought into our emergency room after falling while riding a horse. She complained of pain in the cervical spine. Clinical examinations showed local tenderness at the upper cervical spine and painful impairment of the mobility of the neck, with no signs of neurological impairment. Radiological diagnostics revealed a traumatic C2/3 spondylolisthesis. A computer tomography (CT) angiographic scan showed a dislocation of the right vertebral artery into the fracture gap without injury to the artery. Open reduction and osteosynthesis were considered of too high risk. Therefore, we conducted fracture treatment with closed reduction and halo fixation. After removal of the halo fixator, the patient was given a soft cervical collar and was advised to rest for additional 6 weeks before beginning gradual activity. RESULTS Conventional follow-up revealed osseous consolidation and a CT angiographic scan showed consistent blood flow to the artery. CONCLUSION Halo fixation was a safe and effective therapy strategy in the case of vertebral artery entrapment after traumatic C2 spondylolisthesis.