scholarly journals Management of neglected complex hangman’s fracture by reforming the C2 pedicle: new innovative technique of motion preservation at the C1–2 joint in 2 cases

2020 ◽  
Vol 32 (6) ◽  
pp. 965-972
Author(s):  
Pankaj K. Singh ◽  
Mohit Agrawal ◽  
Dattaraj Sawarkar ◽  
Amandeep Kumar ◽  
Satish Verma ◽  
...  
Keyword(s):  
Neurological Deficits ◽  
Hangman’S Fracture ◽  
Neurological Improvement ◽  
Good Outcome ◽  
Neural Canal ◽  
Hangman's Fracture ◽  
A New Technique ◽  
Low Rate ◽  
Traumatic Spondylolisthesis

Hangman’s fracture, also known as traumatic spondylolisthesis of the axis, causes widening of the neural canal and thus a low rate of neurological deficits. This low rate is one of the reasons it is neglected and patients present with late neurological deficits. In an effort to preserve motion at the C1–2 joint, the authors devised a new technique of bilateral C2 pedicle reconstruction. They describe the first two cases in the literature of an old hangman’s fracture with resorbed C2 pedicles due to chronic fracture, in which bilateral C2 pedicles were reconstructed. One of the two cases (case 2) is the first reported case of severe C2–3 spondyloptosis with C2 displaced up to the level of C4. Case 1 had a follow up of 21 months, while case 2 had a follow up of 12 months. Both patients experienced neurological improvement with evidence of fusion and artificial pedicle formation at last follow-up. Bilateral C2 pedicle reconstruction is a feasible technique that can be used with a good outcome in select patients.

Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases

1996 ◽  
Vol 85 (4) ◽  
pp. 550-554 ◽  
Author(s):  
Domagoj Coric ◽  
John A. Wilson ◽  
David L. Kelly
Keyword(s):  
Current Treatment ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Cervical Fractures ◽  
Flexion Extension ◽  
Hangman's Fracture ◽  
Halo Orthosis ◽  
Traumatic Spondylolisthesis ◽  
Fine Print

✓ Current treatment regimens for hangman's fracture, or traumatic spondylolisthesis of the axis, emphasize rigid immobilization using a halo orthosis. A retrospective study was undertaken to assess the safety and efficacy of nonrigid immobilization in the treatment of these fractures. Records of 64 patients with hangman's fracture treated over a 19-year period (1975–1994) at one institution were reviewed. Thirty-nine of these patients presented with a displacement of C-2 onto C-3 measuring less than 6 mm and no contiguous cervical fractures. All these patients were treated with nonrigid immobilization, consisting primarily of a Philadelphia hard collar worn for 10 to 14 weeks; all showed stable fracture healing on follow-up flexion—extension radiographs. None of the patients experienced neurological sequelae or significant disability at follow-up review. The results of this series indicate that the majority of patients with hangman's fractures, including all patients with displacement measuring less than 6 mm and no contiguous fractures, may be treated successfully with nonrigid immobilization. This management regimen avoids the increased morbidity and cost associated with rigid immobilization using a halo orthosis.

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.

Surgical treatment of syringomyelia

1984 ◽  
Vol 61 (3) ◽  
pp. 531-538 ◽  
Author(s):  
Nicholas M. Barbaro ◽  
Charles B. Wilson ◽  
Philip H. Gutin ◽  
Michael S. B. Edwards
Keyword(s):  
Operative Therapy ◽  
Diagnostic Procedures ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Sensory Loss ◽  
Content Type ◽  
Neurological Improvement ◽  
Leg Stiffness ◽  
Fine Print

✓ The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1½ to 12 years. During the period of this study, metrizamide myelography in conjunction with early and delayed computerized tomography scanning replaced all other diagnostic procedures in patients with syringomyelia. Preoperative accuracy for the two procedures was 87%. The most common symptoms were weakness (79%), sensory loss (67%), pain (38%), and leg stiffness (28%). Surgery was most effective in stabilizing or alleviating pain (100%), sensory loss (81%), and weakness (74%); spasticity, headache, and bowel or bladder dysfunction were less likely to be reversed. Approximately 80% of patients with idiopathic and posttraumatic syringomyelia and 70% of those with arachnoiditis improved or stabilized. Better results were obtained in patients with less severe neurological deficits, suggesting the need for early operative intervention. A higher percentage of patients had neurological improvement with SP shunting than with any other procedure, especially when SP shunting was the first operation performed. Patients treated with SP shunts also had the highest complication rate, most often shunt malfunction. These results indicate that SP shunting is effective in reversing or arresting neurological deterioration in patients with syringomyelia.

scholarly journals A new transpedicular lag-screw fixation for treatment of unstable Hangman’s fracture: a minimum 2-year follow-up study

2020 ◽  
Author(s):  
Yijie Liu ◽  
Yi Zhu ◽  
Xuefeng Li ◽  
Jie Chen ◽  
Sen Yang ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Screw Fixation ◽  
Biomechanical Testing ◽  
Biomechanical Properties ◽  
Hangman’S Fracture ◽  
Lag Screw ◽  
Associated Lesions ◽  
Cord Injury ◽  
Hangman's Fracture

Abstract Background A new C2 transpedicular lag-screw designed by our team has been used in human cadaver spines for biomechanical testing, and the results showed that the biomechanical properties of the new C2 transpedicular lag-screw were better than ordinary screws. The objective of this study is to analyze the clinical efficacy and safety of the new C2 transpedicular lag-screw fixation for treatment of an unstable Hangman’s fracture. Methods From March 2013 to June 2017, 25 patients who had unstable Hangman’s fractures were operated on with a new C2 transpedicular lag-screw fixation. The patients included 18 males and 7 females whose ages ranged from 31–62 years (average 45.4 ± 9.3 years). The cause of the injury was a traffic accident in 17 patients and a fall from height in 8 patients. Other associated lesions included rupture of the spleen (1 patient) and rib fractures (2 patients). According to the Levine-Edwards classification, 17 patients were Type II and 8 patients were Type IIA, and according to the Frankel Neurological Performance scale, 8 cases and 17 cases were graded as spinal cord injury D and E, respectively. Of the cases, 23 cases received bilateral screw fixation and 2 cases had unilateral screw fixation because another pedicle was chipped. The whole procedure was accomplished with monitoring by“C”-arm fluoroscopy. Results The mean follow-up time was (36 ± 12) months and ranged from 24 to 60 months. No obvious symptomatic or radiologic postoperative complications were found during the follow-up period. 6 cases restored from D to E while 2 cases remained D according to American Spinal Injury Association (ASIA) grade. Osseous union was achieved in all cases, and the range of cervical motion recovered to normal level up to the last follow-up. Conclusions The primary clinical and radiographic efficacies of a new C2 transpedicular lag-screw fixation for treatment of an unstable Hangman’s fracture were satisfactory. This approach could be considered a simple, effective, reliable and economic surgical method for managing unstable Hangman’s fractures.

scholarly journals Posterior Stabilization Without Neural Decompression in Osteoporotic Thoracolumbar Fractures With Dynamic Cord Compression Causing Incomplete Neurological Deficits

2020 ◽  
pp. 219256822095695
Author(s):  
Abhinandan Reddy Mallepally ◽  
Nandan Marathe ◽  
Gururaj Sangondimath ◽  
Kalidutta Das ◽  
Harvinder Singh Chhabra
Keyword(s):  
Spinal Injury ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Neurological Impairment ◽  
Cord Compression ◽  
Fracture Site ◽  
Neurological Deficits ◽  
Neurological Improvement ◽  
Indirect Decompression

Study Design: Prospective cohort study. Objectives: Management of osteoporotic vertebral compression fracture (OVCF) remains an unsolved problem for a spine surgeon. We hypothesize that instability at the fracture site rather than neural compression is the main factor leading to a neurological deficit in patients with OVCF. Methods: In this study, the prospective data of patients with osteoporotic fractures with incomplete neurological deficits from January 2015 to December 2017 was analyzed in those who underwent posterior instrumented fusion without neural decompression. Results: A total of 61 patients received posterior indirect decompression via ligamentotaxis and stabilization only. Of these 17 patients had polymethylmethacrylate (PMMA) augmented screws and in 44 patients no PMMA augmentation was done. The mean preoperative kyphosis was 27.12° ± 9.63°, there was an improvement of 13.5° ± 6.87° in the immediate postoperative period and at the final follow-up, kyphosis was 13.7° ± 7.29° with a loss of correction by 2.85° ± 3.7°. The height restoration at the final follow-up was 45.4% ± 18.29%. In all patients, back pain was relieved, and neurological improvement was obtained by at least 1 American Spinal Injury Association Impairment Scale in all except 3 patients. Conclusion: We propose that neural decompression of the spinal cord is not always necessary for the treatment of neurological impairment in patients with osteoporotic vertebral collapse with dynamic mobility. Dynamic magnetic resonance imaging is a valuable tool to make an accurate diagnosis and determine precise surgical plan and improving the surgical strategy of OVCF.

Management of Plasmacytomas of the Spine

Neurosurgery ◽  
1983 ◽  
Vol 13 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Christopher M. Loftus ◽  
Christopher B. Michelsen ◽  
Frederick Rapoport ◽  
J. Lobo Antunes
Keyword(s):  
Symptomatic Relief ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Medical Work ◽  
Systemic Involvement ◽  
Neurological Improvement ◽  
Definition Of ◽  
Work Up

Abstract Epidural plasmacytoma often reflects systemic myelomatous involvement and usually has a poor prognosis. The isolated spinal plasmacytoma, however, is a lesion with the potential for long term remission or even cure in some cases. We report six patients with isolated plasmacytoma of the low thoracic or lumbar region, all of whom presented with pain and minimal neurological deficits. Our approach to such cases included a complete medical work-up and radiographic definition of the lesion with a bone scan, a skeletal survey, myelography, computed tomography, and, in some instances, spinal angiography. All of these patients underwent laminectomy and spinal fusion with autologous bone and harrington rods. There was no morbidity associated with the procedure, which was designed to prevent possible collapse during subsequent radiotherapy or chemotherapy, with its attendant potential for neurological catastrophe. Several patients have developed systemic involvement necessitating chemotherapy, but in follow-up extending now to 4 years all patients remain ambulatory and pain-free. We are encouraged by the potential for symptomatic relief and neurological improvement of patients with isolated spinal plasmacytomas who are treated with an aggressive medical and surgical approach.

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