C1-C3 Lateral Mass Screw-Rod Fixation and Fusion for C2 Pathologies and Hangman's Fractures

Abstract

Study DesignRetrospective clinical study.PurposeWe report our experience of eight patients treated with C1-C3 lateral mass rod-screw stabilization and fusion in the treatment of Hangman's fracture and other axis pathologies.Overview of LiteratureDifferent surgical approaches, both anterior and posterior, have been described for treating Hangman's fracture and other pathologies where surgery is indicated.MethodsAll patients who underwent surgical treatment for Hangman's fracture and axial pathology where C1-C3 lateral mass screw-rod stabilization and fusion done, following reduction of the fracture or removal of the pathology were included in this series. The recorded patient management data was retrospectively studied.ResultsThere were 8 cases in total. All were male, with an average age of 40.75 years. Hangman's fracture occurred in 6 cases (75%), one with metastatic squamous cell carcinoma and the remaining with plasmocytoma. Among the Hangman's fractures 4 (66.66%) had no neuro-deficit. Reduction and bilateral C1-C3 lateral mass screw and rod fixation with posterior fusion by bone graft was performed in all cases. In 2 cases, a C2 body tumor was removed transorally. All patients with neuro-deficit fully recovered, except one who expired in the early post-operative period. Rest of all patients were leading a normal life till last follow up.ConclusionsAlthough the number of cases was very small with a relatively short follow up period, C1 and C3 lateral mass screw-rod fixation followed by fusion showed promise as an effective and biomechanically sound way for the treatment of properly selected Hangman's fracture cases, and may also be suitable in other axial pathologies.

Atlantoaxial instability and cervical noninfectious spondylodiscitis in a patient with Wegener’s granulomatosis: A case report

“… 32 In an exciting series, Chowdhury et al treated eight patients with Hangman's fractures using C1–C3 lateral mass screws while skipping C2 instrumentation, and their results were promising. 33 This technique becomes much more popular if the anatomical properties of C2 are unfit for instrumentation or the surgeon is not experienced in direct C2 instrumented fixation.…”

“…Elliott et al reviewed transarticular screws (TASs) and different screw‐rod constructs (SRCs) for posterior C1‐C2 fixation and found almost equal efficacy and safety of both techniques 32 . In an exciting series, Chowdhury et al treated eight patients with Hangman's fractures using C1–C3 lateral mass screws while skipping C2 instrumentation, and their results were promising 33 . This technique becomes much more popular if the anatomical properties of C2 are unfit for instrumentation or the surgeon is not experienced in direct C2 instrumented fixation.…”

Lateral mass screw fixation in cervical spine injury

“…None of the patients deteriorated after surgical intervention. Other studies, 19 have shown that lateral mass screw-rod fixation followed by fusion shows promise as an effective and biomechanically sound way of treatment in properly selected cervical injury cases.…”

A novel technique for unstable Hangman’s fracture: lag screw-rod (LSR) technique

“…Posterior C1-C3 screw fixation has been reported, and this technique can provide firm stabilization of the cervical spine. However, it is not considered desirable since resulting in a significant loss of intact C1-C2 activity [7]. By contrast, the combined of C2 pedicle (pars) screw and C3 lateral mass screw or C2-C3 pedicle screw fixation is a more effective fixation technique.…”