Analysis of the Cervical Sagittal Alignment in Patients with Unstable Hangman Fracture Under C2∼3 Anterior Discectomy and Fusion

Kong, Weijun; Yang, Xi; Li, Zhongyang; Hu, Bowen; Song, Yueming

doi:10.1016/j.wneu.2019.08.147

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…Thus, the potential for surgery to avoid these problems has caused a general shift in literature to use surgery as a primary treatment option rather than deal with conservative treatment that has failed. 12,17,44,49,52 Various radically different surgical techniques may be employed via the anterior, posterior, or combined approach, and their indications, complications, and outcomes must be better understood to guide surgeons as surgical fixation becomes more commonly used in managing unstable hangman's fractures over conservative management. It remains widely accepted that type I fractures may be managed conservatively-only 14 patients of the 627 included in this review who were given a Levine-Edwards classification were type I, as they had excellent union rates nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Associated discoligamentous injury is frequent, particularly the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL) and intervertebral disc; these structures are crucial to II fractures may be managed with methods ranging from a cervical collar to traction. 11 Despite avoiding the traditional risks of invasive surgery, traction carries its own risks, including deep vein thrombosis, pulmonary infection, and bed sores 12 ; halo traction involving pins has high rates of complications, including pin loosening, overpenetration, and infection. 13 Furthermore, the rate of fusion falls with increasingly unstable fracture patterns managed conservatively: 60% in type II, 45% in type IIA, and 35% in type III.…”

Section: Introductionmentioning

confidence: 99%

“…14 Avoiding the issues associated with prolonged traction and ensuring speedier fusion rates have spurred the popularity of managing unstable hangman's fractures surgically. 12,15 Currently, no clear algorithm exists in guiding the selection of surgical management of hangman's fracture, and selection of treatment options remains controversial. [15][16][17] Surgical approaches can be broadly divided into anterior and posterior-anterior approaches expose the disc and allow anterior cervical discectomy and fusion (ACDF); posterior approaches include direct pedicle screw (DPS), occipitocervical fusion, or multilevel posterior fusion.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Hangman’s Fracture: A Systematic Review

2023

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Background: Hangman's fractures are bilateral fractures of the C2 pars interarticularis produced during hyperextension injuries. The Levine-Edwards classification divides these fractures into 4 categories determined by injury stability. While stable fracture patterns are typically managed conservatively, prolonged traction required in unstable fractures may be superseded by surgery in its practicality. Surgical approaches can be divided into anterior and posterior: the anterior approach allows access to the disc and is used for anterior cervical discectomy and fusion (ACDF); the posterior approach includes C2 direct pedicle screw (DPS), which preserves motion segments and may be done with a minimally invasive surgery (MIS) approach. Multilevel rod and screw fusion provide the strongest biomechanical fixation. This systematic review compares indications, complications, and functional outcomes of different approaches.Methods: A search of multiple databases with keywords "hangman fracture," "hangman's fracture," "axis fracture," and "C2 fracture" was conducted; articles were included if they described the surgical technique and included at least one of the primary outcomes: functional outcomes, complication rates, operation time, and blood loss.Results: A total of 1889 abstracts were screened, 137 full text articles were analyzed, and 36 articles were included, yielding a combined total of 627 patients. ACDF was preferred in unstable fracture patterns. Pre-and postoperative visual analog scale (VAS) scores fell in all groups, with MIS DPS producing the lowest VAS scores. Approaches had excellent neurological improvement and fusion rates. Reported complication rates were generally low; self-limiting dysphagia was most common in the anterior approach and higher volumes of blood loss occured with the posterior approach (255.9 mL in open posterior approach, 75.8 mL in MIS, and 64.3 mL in ACDF).Conclusion: All surgical methods of hangman's fracture fixation have their indications and advantages; surgeons should be equipped to perform all options. Anterior approaches may be preferred for their lower blood loss and access to the disc; however, MIS may improve outcomes in posterior approach.Clinical Relevance: This systematic review can assist spinal surgeons in the selection of the most appropriate surgical option for hangman's fracture and allow surgeons to inform patients of the risks and benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Hangman’s Fracture: A Systematic Review

2023

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“…Long-term outcomes demonstrate maintained improvements in JOA scores [5] and a change in the disease course of cervical myelopathy [14]. The goals of management for CSM was cord decompression, stabilization, preservation, improvement of cord vascularity, and restoration of normal sagittal alignment [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Radiographic Analysis Comparison of Cervical Alignment After Variable Level of Anterior Cervical Discectomy and Fusion (ACDF)

Sornsa-ard¹,

Sribunditkul²,

Vasutara³

et al. 2020

Hong Kong J Orthop Res

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Background: To compare the radiographic cervical lordosis alignment between pre-operative and post-operative surgery after variable level of anterior cervical discectomy and fusion (ACDF) .In the current review, the standard surgical treatment of cervical spondylotic myelopathy is ACDF the restoration and maintenance of cervical lordosis alignment is an important clinical parameter after single level or multilevel anterior cervical discectomy and fusion. The increase or decrease cervical lordosis alignment is affected by the sagittal vertical axis and balance. Methods: This study was performed a retrospective radiographic analysis of 147 patients who underwent single to multilevel ACDF (Total N= 147; 1-level (N=36), 2-level (N=60), 3-level (N=42) and 4-level (N=9)) by orthopedic spine surgeons and neurosurgeons between 2016 and 2018. The authors measured the cervical lordosis alignment of the cervical spine using the Cobb method (Inferior endplate of C2 to inferior endplate of C7) at pre-operative and post-operative surgery. Radiographs were measured by three orthopedic doctor viewers. Statistical analysis were performed using R software. Results: The radiographic analysis comparison of cervical alignment after ACDF was showed the results that cervical lordosis alignment had no significantly change of decreased cervical lordosis alignment at pre-op mean 14.88°(± 8.66) and initial post-op mean 13.01°(±7.65) in all level of ACDF. Conclusions: The radiographic analysis of variable level anterior cervical discectomy and fusion in single to multilevel (1-level, 2-level, 3-level and 4-level) has no significantly change in cervical lordosis alignment after initial postop surgery.

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“…Positive values indicated lordosis, while negative values indicated kyphosis. The C2-7 SVA value was considered to be positive if the C2 plumb line was located in front of the posterior upper corner of the C7 vertebral body, and it was considered to be negative if the C2 plumb line was behind the posterior upper corner of the C7 vertebral body[ 12 ]. To avoid intraobserver bias, all radiological parameters were measured by two attending spinal surgeons who were not involved in the surgery, and the average value of their measurements was used for analysis.…”

Section: Methodsmentioning

confidence: 99%

Sequential sagittal alignment changes in the cervical spine after occipitocervical fusion

Zhu¹,

Wang²,

Chen³

et al. 2022

WJCC

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BACKGROUND There are few studies regarding sequential changes in the sagittal alignment of the upper and lower cervical regions of the spine after occipitocervical fusion (OCF). In addition, no comparisons of cervical sagittal alignment (CSA) between patients with craniocervical junction disorders (CJDs) and normal populations have been reported. AIM To compare the CSA of patients with CJDs with that of normal controls and investigate the sequential changes in the CSA of the upper and lower cervical spine after OCF. METHODS Eighty-four patients who underwent OCF (OCF group) and 42 asymptomatic volunteers (control group) were included. Radiographic parameters, including the occipital to C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2–7 angle (C2-7a), and pharyngeal inlet angle (PIA), were measured and compared pre- and postoperatively. The correlations among the parameters were analyzed using Pearson’s correlation test. RESULTS The O-C2a and PIA of the OCF group were smaller than those of the control group, while their O-EAa and C2-7a values were larger than those of the normal controls. There were no significant differences in O-C2a, C2-7a, or PIA in the OCF group at baseline, 1 mo, or the final follow-up after surgery. The Pearson’s correlation results showed that there were significant correlations between the O-C2a and C2Ta, C2-7a, C2-7 sagittal vertical axis (SVA), and PIA at 1 mo after OCF surgery and between O-C2a and O-EAa, C2Ta, C2-7a, C2-7 SVA, and PIA at the final follow-up. CONCLUSION Patients with CJDs have a more kyphotic upper CSA and a more lordotic lower CSA than normal controls. The effectiveness of OCF surgery in restoring CSA may be limited by the realignment of the craniocervical junction being neglected. The reduction in O-C2a after OCF surgery may increase C2-7a and decrease PIA.

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Analysis of the Cervical Sagittal Alignment in Patients with Unstable Hangman Fracture Under C2∼3 Anterior Discectomy and Fusion

Cited by 5 publications

References 29 publications

Surgical Management of Hangman’s Fracture: A Systematic Review

Surgical Management of Hangman’s Fracture: A Systematic Review

Radiographic Analysis Comparison of Cervical Alignment After Variable Level of Anterior Cervical Discectomy and Fusion (ACDF)

Sequential sagittal alignment changes in the cervical spine after occipitocervical fusion

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