Cervical cage without plating in management of type II / II A Hangman’s fracture combined with intervertebral disc injury

Abstract

BackgroundSurgical intervention is increasingly performed as the primary treatment of unstable Hangman’s fracture. Some authors have advocated using anterior C2/3 discectomy with interbody fusion and plating to treat unstable Hangman’s fracture combined with intervertebral disc injury; however, there are few reports on unstable Hangman’s fracture treated by anterior interbody fusion with the cervical cage (PEEK material) solely.MethodsThis study was to assess the efficacy of the cervical cage in management of unstable Hangman’s fracture combined with intervertebral disc injury. A cohort of 15 patients with unstable Hangman’s fractures fulfilling the inclusion criteria were prospectively submitted to surgical treatment of anterior C2/3 discectomy and interbody fusion using the cervical cage without plating. According to the Levine and Edwards classification, there were 5 type II, and 10 type IIA cases. The clinical outcome (the visual analog scale and the clinical post-traumatic neck score), radiological findings (angulation, translation, and disc height), and bone healing were assessed at 3, 6, 12, and 24 months.ResultsAll the patients were followed up successfully. There were no intra- or postoperative complications observed. Solid fusion was achieved in all cases by 6 months after surgery. The local kyphotic angle was corrected significantly with the mean preoperative 12.31 ± 2.96 degrees, initial postoperative −1.98 ± 1.62 degrees and the latest follow-up −1.72 ± 1.60 degrees respectively (P < 0.05).The translation was also corrected significantly with the mean preoperative 3.20 ± 1.16 mm, initial postoperative 0.97 ± 0.36 mm, and the latest follow-up 1.05 ± 0.34 mm respectively (P < 0.05). The mean visual analog scale and the clinical post-traumatic neck score improved significantly following surgery (P < 0.05).ConclusionsThis case series demonstrates that anterior C2/3 discectomy and interbody fusion with the cervical cage solely is effective and reliable in management of type II / IIA Hangman’s fracture with C2/3 disc injury when properly indicated.

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

“…The patient factors highlighted in their study included open head injuries, skull fractures/laceration, anticipated prolonged ventilation and some unique scenarios like psychosis, advanced pregnancy, and obesity that would make conservative management impractical. 1 However, in another recent study by Wei et al,17 they highlighted that despite the variously described surgical or nonsurgical treatments for Hangman's fracture, optimal treatment remains in question. They elaborated that although nonsurgical treatment were widely favoured in the primary treatment of TSA, healing was slow, uncertain, and treatment course was prolonged 17.…”

“…1 However, in another recent study by Wei et al,17 they highlighted that despite the variously described surgical or nonsurgical treatments for Hangman's fracture, optimal treatment remains in question. They elaborated that although nonsurgical treatment were widely favoured in the primary treatment of TSA, healing was slow, uncertain, and treatment course was prolonged 17. They noted the complications of conservative treatment of Hangman's fracture to include 60% occurrence of anterior dislocation, C2-C3 angulation, pseudoarthrosis and recurrent axial pain 15,17.…”

“…They elaborated that although nonsurgical treatment were widely favoured in the primary treatment of TSA, healing was slow, uncertain, and treatment course was prolonged 17. They noted the complications of conservative treatment of Hangman's fracture to include 60% occurrence of anterior dislocation, C2-C3 angulation, pseudoarthrosis and recurrent axial pain 15,17. They also noted that there is a trend towards preferring surgical treatment as primary management for unstable Hangman's fracture due to the above complications in addition to associated disco-ligamentous injuries, the hope of improving neurological outcome or improving persistent axial pain suffered by patients after treatment with external orthosis 15,17.…”

Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review

“…In 38 of the 146 articles, it was mentioned whether the radiographs were analysed by a radiologist or a clinician. In 26 of these, analysis was performed by a radiologist [10,13,20,24,32,49,50,54,57,58,64,74,85,94,[97][98][99][100][101][102][103][104][105][106][107][108]. They found fusion was achieved in 93.5% of patients after a median follow-up of 23 months.…”

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

“…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.…”