Reduction of displaced Hangman’s fracture by compression across crossed translaminar screws

Min

J Neurol Surg A Cent Eur Neurosurg

et al. 2018

Atypical C2 fractures refer to all fracture types of the C2 body excluding odontoid fractures and traumatic spondylolisthesis of C2. A 55-year-old male patient presented with neck pain after a vehicular accident. Computed tomography (CT) showed an oblique fracture line of the C2 vertebral body through the pedicle and lamina with fracture gap and posterior displacement. We used a clenching reduction technique to treat this fracture by using an ipsilateral laminar screw and contralateral pedicle screw. The final follow-up CT scan showed complete bone union. Neck motion was preserved including rotation. For this unstable atypical C2 fracture, the clenching reduction technique proved to be a safe and effective technique while salvaging neck motion.

Section: Discussionmentioning

confidence: 99%

Clenching Reduction Technique for Osteosynthesis of Atypical C2 Fractures with the Combining Use of Laminar and Pedicle Screw: A Technical Note

Min

J Neurol Surg A Cent Eur Neurosurg

et al. 2018

“…Posterior surgery includes a number of procedures, including C-2 pedicle screw fixation, combined C-2 pedicle and C-3 lateral screw fixation, posterior fixation extended to C-1, and even occipitocervical fusion. 4,8,[17][18][19]21,25 Among the different posterior approaches, direct repair of the pars fracture with a pedicle screw across the fracture line has the advantages of direct compression of the fracture with excellent anatomical reconstruction, preservation of atlantoaxial rotation function, and minimal functional restriction of the cervical spine. 3,8,17,18,25 Many authors have concluded that posterior direct pars screw repair seems to be safer, cheaper, and more technically feasible than other posterior techniques.…”

Section: Discussionmentioning

confidence: 99%

“…3,8,13,15,[17][18][19]21,23,25,28,31,33,34 Posterior surgery was previously performed using C1-3 wire fixation, but this technique requires postoperative halo vest immobilization and sacrifices atlantoaxial function. 13 Bristol et al 3 treated the atlantoaxial isthmus fracture by direct screw fixation to retain atlantoaxial function.…”

mentioning

confidence: 99%

“…8,25 A number of studies reported C-2 isthmus screw fixation combined with C-3 lateral mass screw fixation, or C-1 pedicle fixation combined with C-3 lateral mass screw fixation. 21 However, these techniques are not considered optimal as they result in significant loss of C1-2 function. 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 negative consequences.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Hou

Zhao

et al. 2015

SPI

OBJECT The object of this study was to describe the authors' method of anterior discectomy/corpectomy and fusion combined with internal fixation for the treatment of unstable hangman's fractures and to evaluate the clinical and radiological outcomes. METHODS This study included 38 consecutive patients who underwent surgery for unstable hangman's fractures between July 2002 and October 2011 and were followed up for more than 2 years. The patients were 18 women and 20 men with a mean age of 42.8 years (range 20–69 years). The fracture resulted from a fall in 9 patients, a motor vehicle accident in 21 patients, and a motorcycle accident in 8 patients. The Levine-Edwards classification was Type II in 13 patients, Type IIA in 20 patients, and Type III in 5 patients. All patients underwent 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. Pain was assessed before and after surgery using a visual analog scale (VAS). Myelopathy was graded using the Japanese Orthopaedic Association (JOA) score. Patient satisfaction with the surgery was assessed using Odom's grading system. Anteroposterior, lateral, and dynamic (flexion/extension) radiographs were obtained during the follow-up period. Two-dimensional CT studies with sagittal and coronal reconstructions were routinely performed. RESULTS The mean follow-up period was 49.2 months (range 24–132 months). There was a significant decrease between the preoperative and final follow-up VAS scores (mean [SD] 7.56 ± 1.52 vs 2.36 ± 1.25, p < 0.05) and a significant increase between the preoperative and final follow-up JOA scores (12.58 ± 1.34 vs 16.13 ± 1.17, p < 0.05). Postoperative radiographs showed satisfactory reduction of the fracture in all cases. Postoperative complications included transient neurological deficits (3 cases), hematoma (2 cases), temporary dysphagia (5 cases), temporary hoarseness (2 cases), prolonged pain at the iliac crest donor site (4 cases), and wound infection at the iliac crest donor site (2 cases). Solid fusion was achieved in 94.7% of patients at the final follow-up. CONCLUSIONS Anterior discectomy/corpectomy and fusion combined with internal fixation is a safe and effective procedure for the treatment of unstable hangman's fractures.

Experimental and Therapeutic Medicine

“…However, the stability of the C2-C3 discs was not maintained by this approach due to disc damage (6,7). A number of studies on C2 isthmus screw fixation combined with C3 lateral mass screw fixation, as well as C1 pedicle combined with C3 lateral mass screw fixation, have been reported (8). However, the combination of C1 pedicle and C3 lateral mass screw fixation is not considered desirable since it results in a significant loss of C1-C2 activity.…”

Section: Introductionmentioning

confidence: 99%

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

Liu¹,

Li²,

Wu³

2013

The present study aimed to evaluate the effect of using one-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion in the treatment of unstable hangman’s fracture. A total of 13 patients with unstable hangman’s fractures underwent C2 and C3 pedicle screw fixation, lamina interbody fusion or combined anterior C2-C3 fusion and imaging examinations to evaluate the fracture fixation and healing condition at three days and three months following surgery. Postoperative X-ray and computed tomography (CT) results showed high fracture reduction, good internal fixation position and reliable fracture fixation. The three-month postoperative CT showed good vertebral fracture healing. C2 and C3 pedicle screw fixation has a good curative effect in the treatment of unstable hangman’s fracture. The direct fixation of the fracture enables early ambulation by the patients.