Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases

Li, Fengning; Hou, Shuxun; Zhao, Yantao; Mao, Ningfang; Hou, Tiesheng; Tang, Jiaguang

doi:10.3171/2014.11.spine13959

Cited by 23 publications

(25 citation statements)

References 36 publications

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“…Differing from the posterior approach; Li et al22 considered posterior approaches as not optimal, noting that they result in significant loss of C1–2 function, and that in a highly unstable Hangman's fracture, posterior fixation of C2–3 results in aggravation of the forward displacement of C-2 because of the intraoperative prone position, which may cause iatrogenic injury with extremely adverse consequences. In their study they used anterior C2–3 intervertebral disc excision or C-3 corpectomy, decompression and reduction, interbody implantation of an autologous iliac bone graft, and internal fixation with a titanium plate, and considered this approach to be a safe and effective procedure for the treatment of unstable hangman's fractures 22.…”

Section: Discussionmentioning

confidence: 99%

Management challenges of traumatic spondylolisthesis of the Axis with an unusual C2-C3 posterior subluxation in a paediatric patient: case report and literature review

et al. 2018

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IntroductionPaediatric cervical spine injuries are uncommon. Traumatic spondylolisthesis of the axis (TSA) is commonly encountered in the trauma setting. The management of TSA may be surgical or non-surgical. Decision making is quite challenging depending on patient presentation and nature of injury, and even more so in the paediatric age group.ObjectivesTo present a case report highlighting the challenges in the management of TSA.MethodsWe present an 8 year old male, who sustained a bilateral C2 pars fracture with associated unusual C2-C3 posterior subluxation.ResultsNeuroradiological studies identified the fracture/subluxation of C2-C3 and revealed an intact but posteriorly displaced C2-C3 disc causing cord compression. An Extension Halter traction was initially commenced. This seemed to have worsened the patient's neck pains, and caused motor weakness and autonomic dysfunction. An anterior cervical discectomy and fusion was finally decided on and performed after evaluation and brainstorming by our spinal Unit. Intra-operative findings revealed separation of the C2-C3 disc from the C3 superior end plate which probably explains the unusual nature of the subluxation.ConclusionThe case shows that surgical intervention as a primary management for TSA even in the paediatric age group is safe and also avoids risks inherent in conservative management.

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Section: Discussionmentioning

confidence: 99%

Management challenges of traumatic spondylolisthesis of the Axis with an unusual C2-C3 posterior subluxation in a paediatric patient: case report and literature review

et al. 2018

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“…Type 1 (horizontal fracture) describes a potentially displaced horizontally orientated fracture line through the body of C2 with an intact axis ring comparable to a Benzel 20 type I fracture.…”

Section: Classificationmentioning

confidence: 99%

“…Several authors published good clinical and radiological results either with an isolated anterior approach (ACDF of C2/3), 20 , 28 , 29 with a posterior-only approach, 30 , 31 as well as with a combined posterior-anterior approach. 32 In a recent review, Murphy et al 23 analyzed up-to-date evidence for the best possible approach (ACDF vs posterior fusion vs anterior-posterior fusion) but they did not find any difference in terms of union, mortality, and complications.…”

Section: Treatmentmentioning

confidence: 99%

Treatment of Axis Ring Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Scholz

Kandziora

Kobbe

et al. 2018

Global Spine Journal

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Study Design:Narrative literature review and expert recommendation.Objective:To establish treatment recommendations for axis ring fractures based on the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma.Methods:This recommendation summarizes the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma with regard to the treatment of axis ring fractures based on a narrative literature review.Results:Typical “hangman’s fractures” with bilateral separation of the neural arch from C2 and atypical “hangman’s fractures” with irregular fracture morphology are described. Computed tomography is the “gold” standard used to detect and analyse these fractures adequately. Furthermore, the detection of vertebral artery integrity is necessary. To classify axis ring fractures, the Levine-Edwards or Josten classification is recommended. In particular, the integrity of the C2/3 disc and the integrity of the anterior longitudinal ligament are used to determine the treatment strategy. While Levine-Edwards type I and type IIA (Josten type 1 and 2) fractures should be treated conservatively, Levine type II and type III (Josten type 3 and 4) fractures should be treated operatively. Levine-Edwards type II fractures will be predominately treated by anterior C2/3 fusion. Levine-Edwards type III fractures have to be primary reduced, if an anterior fusion is planned (anterior cervical discectomy and fusion [ACDF] C2/3). If a closed reduction of a type III fracture is impossible, an open reduction and posterior fixation/fusion is the treatment of choice.Conclusion:Conservative treatment is predominantly reserved for Levine-Edwards I and IIA fractures. Operative treatment should be performed in case of Levine-Edwards II and III fractures.

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“…dysphagia was also reported in one case 3,4,[6][7][8][9][10] . Severe persistent dysphagia is caused mainly by dysfunction of the iSLN or HN that traverses the upper cervical anterior region.…”

Section: Discussionmentioning

confidence: 71%

Upper cervical anterior fusion with a particular focus on superior laryngeal nerve and hypoglossal nerve

Okamoto

Azuma

2018

Spine Surg Relat Res

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Introduction: During upper cervical anterior fusion involving C2, the branches of the superior laryngeal and hypoglossal nerves traversing the operative field are at risk for injury, mainly from excessive retraction and/or incidental ligation. These injuries would cause postoperative dysphagia and/or dysphonia that are often transient but might sometimes persist for several months. The aim of this study was to describe our modified approach for upper cervical anterior fusion and to examine the surgical outcomes and postoperative complications in a small case series. Methods: Four patients underwent upper cervical anterior fusion at our institution. Detaching the omohyoid and sternohyoid muscles from the hyoid bone increased the mobility of the hyoid bone and enabled visualization of the thyrohyoid membrane. This maneuver facilitated access to C2 without excessive retraction to the larynx and the hypoglossal nerve traversing above the hyoid bone. Moreover, this maneuver enabled easy identification and dissection of the internal branch of the superior laryngeal nerve piercing the thyrohyoid membrane. Results: Three patients underwent C2-3 fusion and one patient underwent C2-5 fusion followed by instrumentation. In all patients, wide, adequate exposure of C2 and proper instrumentation was achieved, and both the internal branch of the superior laryngeal nerve and the hypoglossal nerve were identified and preserved. No patient experienced remarkable postoperative dysphagia, dyspnea, and dysphonia. Solid union was achieved in all patients. Conclusions: The technique of detaching the infrahyoid muscles from the hyoid bone during upper cervical anterior fusion involving C2 reduced the traction force to the larynx and the hypoglossal nerve, enabled easy identification of the internal branch of the superior laryngeal nerve, and prevented postoperative complications, such as dysphagia.

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Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases

Cited by 23 publications

References 36 publications

Management challenges of traumatic spondylolisthesis of the Axis with an unusual C2-C3 posterior subluxation in a paediatric patient: case report and literature review

Management challenges of traumatic spondylolisthesis of the Axis with an unusual C2-C3 posterior subluxation in a paediatric patient: case report and literature review

Treatment of Axis Ring Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Upper cervical anterior fusion with a particular focus on superior laryngeal nerve and hypoglossal nerve

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