Hangman’s fracture: a clinical review based on surgical treatment of 15 cases

Goel, Atul; Hawaldar, Akshay; Shah, Abhidha; Bhambere, Sagar; Lunawat, Aditya; Singh, Mandeep; Baldha, Mehul; Sudarshan, Nishchith

doi:10.1007/s10143-021-01556-8

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…Therefore, if one 3.5 mm diameter screw is used for fixation, the screw will have a nearly unique path in the pedicle, and it is extremely difficult to adjust the position if the initial placement is not ideal 12 . Trans-injured spine screw placement may also aggravate fracture displacement and angulation 13 . With the recent boom in digital orthopaedic technology, newer navigation robotic-assisted systems are focusing on this challenge for precise guidance of screw placement.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Li,

Du,

Huang

et al. 2023

Sci Rep

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The objective was to compare the clinical efficacy of percutaneous pedicle screw internal fixation with the aid of the TINAVI orthopaedic surgery robot with that of traditional open surgery for Levine–Edward type IIA (postreduction) hangman fractures and to evaluate the safety and efficacy of the TINAVI robot-assisted orthopaedic surgery procedure. The clinical data of 60 patients with Levine–Edward type IIA (postreduction) hangman fractures treated surgically from June 2015 to February 2022 were analysed retrospectively. Among these patients, 25 were treated with percutaneous pedicle screw fixation under TINAVI (the robot group), and 35 were treated with pedicle screw implantation assisted by a conventional C-arm X-ray machine (the traditional operation group). The pedicle screw placement grade was evaluated according to the Rampersaud scale. The correct rate of pedicle screw placement was calculated. The invasion of adjacent facet joints, VAS score (Visual Analogue Scale), NDI score (Neck Disability Index), SF-36 score (36-Item Short-Form Health Survey questionnaire), EQ-5D score (EuroQol-5 dimensions questionnaire) and operation-related data were recorded, and patients were followed up. All patients were followed up for an average of 15.0 ± 3.4 months. The accuracy of screw placement in the robot group was higher than that in the traditional operation group, while the rates of intraoperative blood loss and invasion of the facet joint were lower and the incision length and length of hospital stay were shorter. On the 3rd day after the operation, the VAS score in the robot group was significantly higher than that in the traditional operation group, but there was no significant difference in the NDI score. On the 3rd day after the operation, the SF-36 and EQ-5 questionnaire scores of the robot group were better than those of the traditional operation group. No complications occurred in any of the patients. Postoperative cervical X-ray showed that the cervical vertebra was stable, and there was no fracture, angle or displacement. Postoperative CT showed that all fractures healed, and the average healing time was 3.4 months. The treatment of Levine–Edward IIA (postrepositioning) hangman fractures with percutaneous pedicle fixation assisted by the TINAVI orthopaedic surgery robot can significantly improve screw placement accuracy with a low rate of invasion of the adjacent facet joint, a short operation time, a low bleeding rate, and high patient satisfaction. Although there are still many disadvantages, it still has good prospects for application.

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Section: Discussionmentioning

confidence: 99%

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Li,

Du,

Huang

et al. 2023

Sci Rep

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“…In addition, it is easier for most spinal surgeons to master the techniques of posterior cervical surgery. Although it has been reported that posterior pedicle screw placement has a high risk of injuries to important structures such as vertebral artery and nerve, careful preoperative preparation, including observing vertebral artery course and pedicle morphology, using surgical navigation equipment, and so on, can avoid or reduce these risks [ 9 , 16 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Both anterior and posterior approaches can effectively treat unstable traumatic spondylolisthesis of the axis, resulting in a high rate of fusion of fracture lines [ 4 , 6 ]. No matter anterior or posterior operation, segmental fixation with fusion using autogenous bone graft seems to be the “gold standard” [ 8 , 9 ]. However, autogenous bone graft by iliac crest or others may have many complications, such as pain in the donor area, infection, nerve injury, abdominal organ hernia through the donor area, and so on [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Is it feasible to treat unstable traumatic spondylolisthesis of the axis via posterior fixation without fusion?

Zhang

Li²,

Wang³

2023

BMC Musculoskelet Disord

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Background Few studies reported treatment of unstable traumatic spondylolisthesis of the axis using posterior fixation without fusion. The aim of this study was to evaluate the results and feasibility of posterior fixation without fusion in treating unstable traumatic spondylolisthesis of the axis. Methods Eleven patients with traumatic spondylolisthesis of the axis were included in this study, and posterior fixation without fusion using screw-rod system was performed for them. The clinical outcomes were assessed using the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the Odom’s grading system. Plain radiography was used to measure the displacement and angulation of C2-C3, and cervical lordosis. Plain radiography and computed tomography were also used to observe the bony fusions of fracture lines and postoperative spontaneous fusion of C2-C3. Results The mean follow up time was 24.6 months (range, 12–72 months). The VAS and NDI scores were significantly improved at the final follow-up compared with those before operation (P < 0.05), and according to Odom’s criteria, 90.9% (10/11) of patients rated their level of satisfaction as excellent or good. The angulation and displacement of C2-C3, and cervical lordosis were significantly improved after operation compared with those before operation (P < 0.05), and at the final follow-up, and these radiological parameters were maintained. All patients achieved solid bony fusions of fracture lines. No operative segment instability was found in all patients during the follow-up period. Spontaneous fusion at bilateral C2-C3 facet joints was found in 11 cases, and anterior and/or posterior bony bridge of intervertebral bodies at C2-C3 was found in 9 cases. Conclusions Posterior fixation without fusion may be a feasible and effective option for unstable traumatic spondylolisthesis of the axis.

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“…All classification schemes (Effendi, Levine, Francis, Goel) claim to provide a statement about stability. [ 3 4 5 8 9 ] They however, are all based on static radiographs and hence do not assess the disco-ligamentous complex at C2-3 disc, ALL, and PLL. [ 8 10 ] The MRI features of the instability of these fractures include significant angulation between C2-3 ≥11°, significant translation of C2-3 ≥3.5 mm, teardrop fragment endplate C2 or C3 (bony avulsion of ALL), disc rupture/edema (MRI), hyper lordotic angulation C2-3 (Dynamic X-ray in extension).…”

Section: Discussionmentioning

confidence: 99%

“…in their analysis of 15 cases of Hangman's elucidated the complex nature of the problem at hand numerous options through posterior approach in stabilizing the spine. [ 9 ] Shah et al . described successful posterior approach even in a 7-year-old with osteopetrosis.…”

Section: Discussionmentioning

confidence: 99%

Saradhi’s single stage, anterior sequential reduction utilizing C3 for type III hangman’s fracture

Mudumba

Pavan

Alugolu

2022

Journal of Craniovertebral Junction and Spine

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Background: Levine Edward's Type III Hangman's fractures are highly unstable and in absence of level 1 evidence, the treatment is individualized. A longer cantilever beam can achieve not just reduction of highly displaced fragments but can also provide a stable construct without the need of global instrumentation. Objective: We extrapolated the surgical techniques of the long cantilever beam to this rare group of cohorts for anterior alone, sequential reduction utilizing C3 rather than sacrificing in a single sitting and single approach. Materials and Methods: This is a prospective observational study from 2015 to 2019, of all consecutive 10 patients diagnosed and treated as Type III Hangman's fracture in the Department of Neurosurgery. Clinical evaluation and pain scores were recorded in the preoperative assessment. Radiological investigations included plain roentgenograms in anterior-posterior and lateral views, magnetic resonance imaging, and computed tomography scan of the cervical spine. Preoperative cervical traction was placed in all cases for the achievement of facetal reduction. The high cervical extra-pharyngeal approach was utilized for discectomy, bone grafting, reduction, and sequential plating. Results: Complete reduction was achieved in all the cases and none required additional posterior surgery. There was a significant decrease in axial neck pain with complete fusion of the graft, and healing of fracture site. Conclusion: The anterior alone approach with a longer cantilever for primary internal stabilization is a technically safe and suitable option for unstable Type III Hangman's fracture.

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Hangman’s fracture: a clinical review based on surgical treatment of 15 cases

Cited by 8 publications

References 18 publications

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Is it feasible to treat unstable traumatic spondylolisthesis of the axis via posterior fixation without fusion?

Saradhi’s single stage, anterior sequential reduction utilizing C3 for type III hangman’s fracture

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