Abstract
1. The clinical experience of fourteen cases of traumatic spondylolisthesis of the axis is described.
2. Evidence is presented which suggests that vertical compression and extension forces are frequently involved.
3. Treatment is based on recognition of the deforming force and its extent.
4. Primary treatment of unstable lesions by the coronally placed bone dowel of Barbour allows early stabilisation and long-term security.
5. The increased antero-posterior diameter of the axis explains the low incidence of spinal cord damage.
6. Skull traction is considered illogical in that it runs parallel in effect to the most deadly form of judicial hanging.
7. Secondary stability following injury may allow continuing force to fracture the spine at other levels.
8. The paradox of an extension injury between the second and third cervical vertebrae and a "flexion" injury at a lower level is discussed.
