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

2009 ◽  
Vol 11 (4) ◽  
pp. 379-387 ◽  
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.

Are C2 pars-pedicle screws alone for type II Hangman's fracture overrated?

2016 ◽  
Vol 141 ◽  
pp. 7-12 ◽  
Author(s):  
Pravin Salunke ◽  
Sushanta K. Sahoo ◽  
Prasad Krishnan ◽  
Debarshi Chaterjee ◽  
Harsimrat Bir Singh Sodhi
Keyword(s):  
Pedicle Screws ◽  
Type Ii ◽  
Hangman’S Fracture ◽  
Hangman's Fracture

Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis

2015 ◽  
Vol 22 (5) ◽  
pp. 459-465 ◽  
Author(s):  
Avery Lee Buchholz ◽  
Steven L. Morgan ◽  
Leslie C. Robinson ◽  
Bruce M. Frankel
Keyword(s):  
Minimally Invasive ◽  
Screw Fixation ◽  
Dynamic Imaging ◽  
Cervical Collar ◽  
Type I ◽  
Type Ii ◽  
Percutaneous Screw Fixation ◽  
Hangman’S Fracture ◽  
Hangman's Fracture ◽  
Traumatic Spondylolisthesis

OBJECT Most cases of traumatic spondylolisthesis of the axis (hangman's fracture) can be treated nonoperatively with reduction and subsequent immobilization in a rigid cervical collar or halo. However, in some instances, operative management is necessary and can be accomplished by using either anterior or posterior fusion techniques. Because open posterior procedures can result in significant blood loss, pain, and limited cervical range of motion, other less invasive options for posterior fixation are needed. The authors describe a minimally invasive, navigation-guided technique for surgical treatment of Levine-Edwards (L-E) Type II hangman's fractures. METHODS For 5 patients with L-E Type II hangman's fracture requiring operative reduction and internal fixation, percutaneous screw fixation directed through the fracture site was performed. This technique was facilitated by use of intraoperative 3D fluoroscopy and neuronavigation. RESULTS Of the 5 patients, 2 were women, 3 were men, and age range was 46–67 years. No intraoperative or postoperative complications occurred. All patients wore a rigid cervical collar, and flexion-extension radiographs were obtained at 6 months. For all patients, dynamic imaging demonstrated a stable construct. CONCLUSIONS L-E type II hangman's fractures can be safely repaired by using percutaneous minimally invasive surgical techniques. This technique may be appropriate, depending on circumstances, for all L-E Type I and II hangman's fractures; however, the degree of associated ligament injury and disc disruption must be accounted for. Percutaneous fixation is not appropriate for L-E Type III fractures because of significant displacement and ligament and disc disruption. This report is meant to serve as a feasibility study and is not meant to show superiority of this procedure over other surgical options.

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

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

SOMI brace immobilization as a treatment option for inveterate hangman’s fracture in pediatric patients

2014 ◽  
Vol 2 (1-4) ◽  
Author(s):  
Alessandro Landi ◽  
Pasquale Donnarumma ◽  
Alfredo Altomonte ◽  
Roberto Delfini ◽  
Giampaolo Cantore
Keyword(s):  
Conservative Treatment ◽  
Rare Case ◽  
Pediatric Patients ◽  
Compression Force ◽  
Halo Vest ◽  
Hangman’S Fracture ◽  
X Ray ◽  
Principles Of Treatment ◽  
Hangman's Fracture ◽  
Traumatic Spondylolisthesis

AbstractTraumatic spondylolisthesis of C2 occurs when the mechanical event at the base of the trauma is a compression force on the vertex. Management of this is well defined in literature, and both surgical and conservative treatments have been proposed in adults. In contrast, the principles of treatment are somewhat more uncertain and less well defined in children. One of the most frequently suggested treatments is the early reduction of the fracture, with immobilization in halo. Other types of cervical orthoses are not recommended. This article reports on a rare case of an inveterate hangman’s fracture in a 12-year-old girl that is healing completely through immobilization in a SOMI brace that was applied 4 months after the trauma. In our experience, hangman’s fracture is poorly defined with regard to the treatment of pediatric patients, and there are currently no established guidelines. If dynamic X-ray scans show complete reduction of the fracture, conservative treatment is an efficient, effective, and noninvasive solution, even in case of inveterate fractures. Halo vest and SOMI brace are good solutions. SOMI brace is an available option because it is less traumatic for the patient.

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

2018 ◽  
Vol 8 (2_suppl) ◽  
pp. 18S-24S ◽  
Author(s):  
Matti Scholz ◽  
Frank Kandziora ◽  
Philipp Kobbe ◽  
S. Matschke ◽  
Philipp Schleicher ◽  
...  
Keyword(s):  
Literature Review ◽  
Fracture Morphology ◽  
German Society ◽  
Posterior Fixation ◽  
Type I ◽  
Anterior Fusion ◽  
Type Ii ◽  
Type Iii ◽  
Narrative Literature ◽  
Narrative Literature Review

Study Design: Narrative literature review and expert recommendation. Objective: To establish treatment recommendations for axis ring fractures based on the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma. Methods: This recommendation summarizes the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma with regard to the treatment of axis ring fractures based on a narrative literature review. Results: Typical “hangman’s fractures” with bilateral separation of the neural arch from C2 and atypical “hangman’s fractures” with irregular fracture morphology are described. Computed tomography is the “gold” standard used to detect and analyse these fractures adequately. Furthermore, the detection of vertebral artery integrity is necessary. To classify axis ring fractures, the Levine-Edwards or Josten classification is recommended. In particular, the integrity of the C2/3 disc and the integrity of the anterior longitudinal ligament are used to determine the treatment strategy. While Levine-Edwards type I and type IIA (Josten type 1 and 2) fractures should be treated conservatively, Levine type II and type III (Josten type 3 and 4) fractures should be treated operatively. Levine-Edwards type II fractures will be predominately treated by anterior C2/3 fusion. Levine-Edwards type III fractures have to be primary reduced, if an anterior fusion is planned (anterior cervical discectomy and fusion [ACDF] C2/3). If a closed reduction of a type III fracture is impossible, an open reduction and posterior fixation/fusion is the treatment of choice. Conclusion: Conservative treatment is predominantly reserved for Levine-Edwards I and IIA fractures. Operative treatment should be performed in case of Levine-Edwards II and III fractures.

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