Anterior Cervical Discectomy and Fusion Versus Posterior Fixation and Fusion of C2–3 for Unstable Hangman’s Fracture

Abstract Background: The overwhelming majority of hangman’s fractures cause anterior dislocation of C2. Hangman’s fracture with C2 posterior dislocation is extremely rare, only one paediatric case was reported in 2018 to date. This kind of injury cannot be catalogued using current classification schemes and no established treatment recommendations exist. The purpose of this article is to report a rare case of a hangman's fracture with C2 posterior dislocation, which does not fit into existing classification systems, propose a new subtype of hangman’s fractures, and discuss management technical notes for the new subtype to avoid pitfalls. Methods: Description of case, review of relevant literatures and share our experience.Results: A 31-year-old male sustained hangman’s fracture with C2 posterior dislocation after fell into a 50cm deep roadside ditch when riding a motorcycle. Radiograph and computed tomography (CT) on admission showed fractures through both pars of C2 and C2 posterior dislocation. Magnetic resonance imaging (MRI) on admission showed high T2-weighted signal intensity of cervical spinal cord and compression of cervical spinal cord by posterior dislocation of C2 vertebral body. After 5 days of skull traction with 5 kg weight before operation, the dislocation aggravated. A C2-3 anterior cervical discectomy and fusion (ACDF) was performed. At 6 months after operation, bony fusion was achieved, and MRI showed the T2-weighted signal hyperintensity of cervical spinal cord before surgery disappeared.Conclusion: We proposed a new subtype of hangman's fractures here, type IIb hangman’s fractures: type II hangman’s fracture with C2 posterior dislocation. C2–C3 ACDF is recommended for type IIb hangman’s fractures. Traction before surgery is not recommended.

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Posterior fixation for paediatric and adolescent unstable hangman’s fracture: evolution to C1 sparing techniques

Child s Nervous System ◽

10.1007/s00381-021-05140-9 ◽

2021 ◽

Author(s):

Mohit Agrawal ◽

Dattaraj Sawarkar ◽

Pankaj Kumar Singh ◽

Shashwat Mishra ◽

Rajesh Meena ◽

...

Keyword(s):

Posterior Fixation ◽

Hangman’S Fracture ◽

Fracture Evolution ◽

Hangman's Fracture

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Posterior fixation and fusion of unstable Hangman’s fracture by using intraoperative three-dimensional fluoroscopy-based navigation

European Spine Journal ◽

10.1007/s00586-011-2085-y ◽

2011 ◽

Vol 21 (5) ◽

pp. 863-871 ◽

Cited By ~ 26

Author(s):

Wei Tian ◽

Chong Weng ◽

Bo Liu ◽

Qin Li ◽

Lin Hu ◽

...

Keyword(s):

Three Dimensional ◽

Posterior Fixation ◽

Hangman’S Fracture ◽

Hangman's Fracture

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Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

Journal of Clinical Medicine ◽

10.3390/jcm7120469 ◽

2018 ◽

Vol 7 (12) ◽

pp. 469 ◽

Cited By ~ 2

Author(s):

Paul Oni ◽

Rolf Schultheiß ◽

Kai-Michael Scheufler ◽

Jakob Roberg ◽

Ali Harati

Keyword(s):

Cervical Spine ◽

Intraoperative Complications ◽

Posterior Longitudinal Ligament ◽

Anterior Cervical Discectomy ◽

Posterior Fixation ◽

Cervical Discectomy ◽

Japanese Orthopedic Association ◽

Cervical Spondylodiscitis ◽

Cervical Fractures ◽

Scale Scores

Background: Multilevel anterior cervical decompression and fixation of four and more levels is a common surgical procedure used for several diseases. Methods: We reviewed the radiological and clinical outcomes after anterior cervical discectomy or corpectomy and fixation of four and more levels in 85 patients (55 men and 30 women) with an average age of 59.6 years. Surgical indication was multilevel cervical degenerative myelopathy and radiculopathy in 72 (85%) patients, multilevel cervical spondylodiscitis in four (5%), complex traumatic cervical fractures in four (5%), metastatic cervical spine tumor in two (2%), and ossification of the posterior longitudinal ligament in three (3%) patients. Results: There were no severe intraoperative complications such as spinal cord or vertebral artery injury or dissection. Seventy-three patients had four, 10 patients had five, and two patients had six anterior cervical level fixations. The visual analog scale (VAS) and Japanese Orthopedic Association (mJOA) scale scores improved (6.9 to 1.3 (p < 0.001) and 13.9 to 16.5 (p < 0.001), respectively). The Cobb angle increased from 5.7° to 17.6° postoperatively (p < 0.001). Secondary posterior fixation was necessary in three cases due to pseudarthrosis. Conclusion: The anterior approach appears to be optimal for ventral compressive pathology and lordosis restoration to the cervical spine. Limitations of multiple level decompression and fixation included increasing pseudoarthrosis rates, especially after corpectomy, and increasing fused level numbers.

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Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques

Journal of Neurosurgery Spine ◽

10.3171/2009.4.spine08516 ◽

2009 ◽

Vol 11 (4) ◽

pp. 379-387 ◽

Cited By ~ 22

Author(s):

Prashant Chittiboina ◽

Esther Wylen ◽

Alan Ogden ◽

Debi P. Mukherjee ◽

Prasad Vannemreddy ◽

...

Keyword(s):

Pedicle Screws ◽

Biomechanical Study ◽

Posterior Fixation ◽

Anterior Fusion ◽

Type Ii ◽

Hangman’S Fracture ◽

Fresh Frozen ◽

Hangman's Fracture ◽

Flexion And Extension ◽

Traumatic Spondylolisthesis

Object Surgical management of unstable traumatic spondylolisthesis of the axis includes both posterior and anterior fusion methods. The authors performed a biomechanical study to evaluate the relative stability of anterior fixation at C2–3 and posterior fixation of C-1 through C-3 in hangman's fractures. Methods Fresh-frozen cadaveric spine specimens (occipital level to T-2) were subjected to stepwise destabilization of the C1–2 complex, replicating a Type II hangman's fracture. Intact specimens, fractured specimens, and fractured specimens with either anterior screw and plate or posterior screw and rod fixation were each tested for stability. Each spine was subjected to separate right and left rotation, bending, flexion, and extension testing. Results Anterior fixation restored stiffness in flexion and extension movements to values greater than those for intact specimens. For other movement parameters, the values approximated those for intact specimens. Posterior fixation increased the stiffness to above those values seen for anterior fixation specimens. Conclusions In cadaveric spine specimens subjected to a Type II hangman's fracture, both anterior fixation at C2–3 and posterior fixation with C-1 lateral mass screws and C-2 and C-3 pedicle screws resulted in a consistent increase in stiffness, and hence in stability, over intact specimens.

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