Spectrum of the hangman's fracture

1976 ◽  
Vol 45 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Edward L. Seljeskog ◽  
Shelley N. Chou
Keyword(s):  
Basic Mechanism ◽  
Upper Cervical Spine ◽  
Fracture Treatment ◽  
Mechanism Of Injury ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Upper Cervical ◽  
Fracture Instability ◽  
Hangman's Fracture ◽  
Fine Print

✓ The authors review their experience in managing 26 cases of “hangman's fracture.” The basic mechanism of injury was hyperextension of the upper cervical spine. Radiographic studies revealed a spectrum of injury beginning with the classical hangman's fracture and progressing to the simple C-2 laminar-pedicle fracture. Appreciation of the fracture instability will dictate the method and duration of fracture treatment. Management by a closed, nonoperative means resulted in solid union of the bone in all fully treated cases, with a minimum of morbidity.

Fractures of the C-2 vertebral body

1994 ◽  
Vol 81 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Edward C. Benzel ◽  
Blaine L. Hart ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
William W. Orrison ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Body Fracture ◽  
Pars Interarticularis ◽  
Upper Cervical ◽  
Type 3 ◽  
Fine Print

✓ Vertical C-2 body fractures are presented in 15 patients with clinical and imaging correlations that suggest the existence of a variety of mechanisms of injury. In these patients, clinical and imaging correlations were derived by: 1) defining the point of impact by clinical examination; 2) defining the point of impact by soft-tissue changes on cranial magnetic resonance (MR) imaging or computerized tomography (CT); 3) obtaining an accurate history of the mechanism of injury; and 4) spine imaging (x-ray studies, CT, and MR imaging) of the C-2 body fracture and surrounding bone and soft tissue. The cases presented involve the region located between the dens and the pars interarticularis of the axis. Although these fractures are rarely reported, they are not uncommon. An elucidation of their pathological anatomy helps to further the understanding of the mechanistic etiology of upper cervical spine trauma. A spectrum of mechanisms of injury causing upper cervical spine fractures was observed. The type of injury incurred is determined predominantly by the force vector applied during impact and the intrinsic strength and anatomy of C-2 and its surrounding spinal elements. From this clinical experience, two types of vertical C-2 body fractures are defined and presented: coronally oriented (Type 1) and sagittally oriented (Type 2). A third type of C-2 body fracture, the horizontal rostral C-2 fracture (Type 3), is added for completeness; this Type 3 fracture is the previously described Type III odontoid process fracture described by Anderson and D'Alonzo.

Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients

1999 ◽  
Vol 90 (1) ◽  
pp. 206-219 ◽  
Author(s):  
Eduardo Salas ◽  
Laligam N. Sekhar ◽  
Ibrahim M. Ziyal ◽  
Anthony J. Caputy ◽  
Donald C. Wright
Keyword(s):  
Cervical Spine ◽  
Medulla Oblongata ◽  
Sigmoid Sinus ◽  
Vascular Lesions ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Bypass Procedure ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Fine Print

Object. The aim of this study was to describe six variations of the extreme-lateral craniocervical approach, their application, and treatment results. Methods. During a 4-year period 69 patients underwent surgery in which six variations of the extreme-lateral craniocervical approach were performed. The variations included: the transfacetal approach (TFA), performed to treat four lesions in the upper cervical spine anterior or anterolateral to the spinal cord; the retrocondylar approach, to treat five intradural lesions located anterolateral to the medulla oblongata and six vascular lesions to expose the extradural segment of the vertebral artery (VA); the partial transcondylar approach (PTCA), to treat 18 intradural lesions located anterior to the medulla oblongata; the complete transcondylar approach (CTCA), to treat 13 extradural lesions that involved the lower clivus and anterior upper cervical spine; the extreme-lateral transjugular approach, to treat 14 jugular foramen tumors; and the transtubercular approach with or without division of the sigmoid sinus, to treat complex VA and vertebrobasilar junction aneurysms. An anatomical prosection was performed to study the surgical exposure of each of the six variations of the extreme-lateral craniocervical approach. Total removal was achieved in 35 (69%) of the patients with tumor; subtotal resection was achieved in 16 (31%) of those patients. In the 12 patients with VA aneurysms, seven underwent clipping, three underwent trapping and a vein graft bypass procedure, and two underwent trapping without the use of a bypass procedure. In five other patients, different cystic, inflammatory, and other vascular lesions were successfully treated. Fifty percent of the patients who underwent surgery via the TFA, 83% via the of the CTCA, and 11% via the PTCA required an occipitocervical fusion procedure. The mean Karnofsky Performance Scale score was 74.7 preoperatively and 76.4 postoperatively. Major complications were hydrocephalus (nine patients), cerebrospinal fluid leakage (seven patients), worsened cranial nerve function (seven patients), vertebrobasilar vasospasm (one patient), and sigmoid sinus thrombosis (one patient). Conclusions. To treat lesions in the region of the foramen magnum and surrounding areas, the approach should be tailored to each specific lesion to provide the needed exposure without unnecessary operative steps.

Fracture of a sublaminar stainless steel cable in the upper cervical spine with neurological injury

1994 ◽  
Vol 81 (6) ◽  
pp. 932-933 ◽  
Author(s):  
J. Bob Blacklock
Keyword(s):  
Stainless Steel ◽  
Cervical Spine ◽  
Spinal Canal ◽  
Neurological Injury ◽  
Upper Cervical Spine ◽  
Steel Cable ◽  
Content Type ◽  
Atlantoaxial Fusion ◽  
Upper Cervical ◽  
Fine Print

✓ Sublaminar cables have been used to stabilize bone grafts for arthrodesis in the cervical spine in recent years. Previous accounts of their use have indicated no instances of breakage or neurological injury. This report is of a delayed cable fracture that resulted in penetration of the dura with neurological injury in a patient who had undergone atlantoaxial fusion for rheumatoid subluxation. The cable fracture occurred in the epidural space beneath the attempted arthrodesis and resulted in uncoiling of the cable, which penetrated the spinal canal and caused a one-sided sensory deficit.

Traumatic atlantooccipital dislocation

1977 ◽  
Vol 46 (5) ◽  
pp. 663-666 ◽  
Author(s):  
Alan H. Fruin ◽  
Thomas P. Pirotte
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Upper Cervical Spine ◽  
Nerve Injuries ◽  
Content Type ◽  
Traumatic Dislocation ◽  
Upper Cervical ◽  
Cranial Nerve Injuries ◽  
Atlantooccipital Dislocation ◽  
Fine Print

✓ A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.

Bone erosion of the cervical vertebrae secondary to tortuosity of the vertebral artery

1980 ◽  
Vol 53 (1) ◽  
pp. 106-108 ◽  
Author(s):  
Daniel F. Cooper
Keyword(s):  
Vertebral Artery ◽  
Bone Erosion ◽  
Cervical Vertebrae ◽  
Vertebral Angiography ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Hangman's Fracture ◽  
Fine Print

✓ A case of “hangman's fracture” is presented, with erosion of the cervical vertebrae by tortuosity of the vertebral artery. The necessity for vertebral angiography in the evaluation of cervical bone-destructive lesions is stressed.

Fusion and instrumentation at C1–3 via the high anterior cervical approach

2000 ◽  
Vol 92 (1) ◽  
pp. 24-29 ◽  
Author(s):  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Solid Fusion ◽  
Posterior Procedure ◽  
Fine Print

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1–3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1–3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital—C1 mobility.

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.

Cervical spine injuries in infants

1975 ◽  
Vol 42 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Lynn M. Gaufin ◽  
Stanley J. Goodman
Keyword(s):  
Cervical Spine ◽  
Fracture Dislocation ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Hangman's Fracture ◽  
Therapeutic Considerations ◽  
Fine Print ◽  
Posterior Elements

✓ The authors point out the unique anatomical and therapeutic considerations involved in injuries of the cervical spine and cord in infants. The special problems encountered in the treatment of such patients are illustrated by three cases, a “Hangman's” fracture, a C6–7 fracture-dislocation, and an acute quadriparesis associated with dysgenesis of the posterior elements of C1–3.

Completely dislocated hangman's fracture with a locked C2–3 facet

1997 ◽  
Vol 87 (5) ◽  
pp. 757-760 ◽  
Author(s):  
Won Gyu Choi ◽  
A. Giancarlo Vishteh ◽  
Jonathan J. Baskin ◽  
Frederick F. Marciano ◽  
Curtis A. Dickman
Keyword(s):  
Spinal Cord ◽  
Rare Case ◽  
Anterior Dislocation ◽  
Industrial Accident ◽  
Neural Arch ◽  
Posterior Decompression ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Hangman's Fracture ◽  
Fine Print

✓ The authors report a rare case of a hangman's fracture involving complete dislocation of C-2 onto C-3, accompanied by a C2–3 locked facet and asymptomatic bilateral vertebral artery injuries. The patient, a 25-year-old man who sustained a neck injury in an industrial accident, presented with a mild central spinal cord syndrome. His initial lateral cervical radiograph showed complete anterior dislocation of the C-2 body onto C-3, bilateral neural arch fractures, and a unilateral locked facet. The mechanism was likely flexion and compression. The grossly unstable spine and the locked facet were treated by posterior decompression, reduction, and C1–3 fixation. The patient recovered in several days and is without neurological deficit.

En bloc resection of multilevel cervical chordoma with C-2 involvement

2005 ◽  
Vol 2 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Laurence D. Rhines ◽  
Daryl R. Fourney ◽  
Abdolreza Siadati ◽  
Ian Suk ◽  
Ziya L. Gokaslan
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Biological Behavior ◽  
Upper Cervical Spine ◽  
En Bloc ◽  
Content Type ◽  
Upper Cervical ◽  
The Right ◽  
Cervical Chordoma ◽  
Fine Print

✓ Chordomas are locally aggressive neoplasms with an extremely high propensity to recur locally following resection, despite adjuvant therapy. This biological behavior has led most authors to conclude that en bloc resection provides the best chance for the patient's prolonged disease-free survival and possible cure. The authors present a case of an extensive upper cervical chordoma treated by en bloc resection, reconstruction, and long-segment stabilization. Total spondylectomy of C2–4 with sacrifice of the right C2–4 nerve roots and a segment of the right vertebral artery was performed. The inherent anatomical complexities of en bloc resection in the upper cervical spine are discussed. To the authors' knowledge, this represents the first report of an en bloc resection for multilevel cervical chordoma.

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