One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture

Liu, Jingchen; Li, Ye; Wu, Yuntao

doi:10.3892/etm.2013.898

Cited by 21 publications

(15 citation statements)

References 20 publications

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“…Some authors insisted that nonsurgical management was inappropriate in patients with unstable Hangman’s fractures and discoligamentous injuries, due to the absence of a blood supply to the disc, which is unable to repair itself. [ 20 ] This frustrating fact could explain why many surgeons choose primary operation in management of unstable Hangman’s fracture [ 8 , 21 – 23 ], which could shorten the course of treatment [ 24 ]. Another reason for operation is that surgical intervention is employed in the hope of improving neurological outcome [ 5 ] or for patients suffering persistent pain from the cervical spine after treated with an external orthosis.…”

Section: Discussionmentioning

confidence: 99%

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

Wei

Wang

Zhou

et al. 2015

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

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

Wei

Wang

Zhou

et al. 2015

BMC Musculoskelet Disord

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show abstract

Section: Discussionmentioning

confidence: 99%

Anterior-only stabilization using cage versus plating with bone autograft for the treatment of type II/IIA Hangman’s fracture combined with intervertebral disc injury

et al. 2015

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BackgroundAnterior C2/3 discectomy and interbody fusion (ACDF) with plating is increasingly performed as the primary treatment of unstable Hangman’s fracture; however, plate-related complications, such as screw back-out, plate fracture and soft-tissue injury, is not uncommon. Polyetheretherketone (PEEK) cage has now been developed to provide initial stability before fusion; however, whether and how ACDF with PEEK cage offer better clinical results compared with ACDF with plating in management of Hangman’s fracture remains unknown. This study compares the efficacy of ACDF with plating to that of ACDF with PEEK cage in management of type II/IIA Hangman’s fractures (according to Levine and Edwards classification) retrospectively.MethodsFrom February 2006 to March 2012, a total of 21 patients with type II/IIA Hangman’s fractures combined with intervertebral disc injury underwent ACDF with PEEK cage, and 28 patients underwent ACDF with plating. Perioperative parameters were compared. The average follow-up period was 50.3 months (range 27–76 months). The clinical outcome (visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, and clinical post-traumatic neck score (PTNC)) and radiological outcome (translation of C2, local kyphotic angle (LKA), and fusion status of C2/3) was compared retrospectively.ResultsThe operative time and blood loss were significantly less in the ACDF with cage group compared with that in the ACDF with plating group (P < 0.05). All patients showed neurological recovery and achieved solid fusion. There were no significant differences in the clinical and radiological outcomes at final follow-up between groups, except in the LKA and the correction loss rate of LKA which were higher in the ACDF with plating group (P < 0.05). Donor-site pain occurred in two patients (10.1%) within 6 months after operation in the ACDF with plating group and none in the ACDF with cage group. All patients recovered without any adverse effects.ConclusionsACDF with PEEK cage is effective and reliable in management of type II/IIA Hangman’s fractures and is more cost-effective due to shorter operative time and less blood loss requirements.

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“…Some surgical tips involve pressing down forcibly when screws implanted, increasing the length of the C2 screws for fixation bicortically, and expanding the screw path behind the fracture line simulating lag screw technique [10][11][12]. However, these tips are dangerous or difficult.…”

Section: Introductionmentioning

confidence: 98%

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

Wang

Yang

et al. 2016

Eur Spine J

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One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture

Cited by 21 publications

References 20 publications

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

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

Anterior-only stabilization using cage versus plating with bone autograft for the treatment of type II/IIA Hangman’s fracture combined with intervertebral disc injury

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

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