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

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.

The efficacy of single-segment anterior decompression, fixation and fusion in the treatment of traumatic spondylolisthesis of the axis

Background This study evaluated the clinical efficacy of single-segment anterior decompression, fixation and fusion in patients with traumatic spondylolisthesis of the axis. Methods From January 2008 to January 2017, 49 patients with traumatic spondylolisthesis of the axis were treated in our centre using single-segment anterior decompression, fixation and fusion. Clinical and radiographic results were analysed. Clinical efficacy was evaluated according to the operative time and blood loss. The Frankel scale was used to evaluate neurological function. A visual analogue scale was used to assess neck pain. Bone graft fusion, instrumentation failure and cervical curvature were monitored via radiography. Results The operative time and intraoperative blood loss of the 49 patients averaged 90.5 ± 4.6 min and 118.5 ± 38.12 ml, respectively. Intervertebral bone grafts were fused in patients with an average fusion time of 6.7 ± 1.0 months (range, 5–8). Cervical curvature was significantly higher at 3 months and 1 year after surgery than before surgery, and the American Spinal Cord Injury Association score at 12 months after surgery was significantly higher than that before surgery. Conclusion Single-segment anterior decompression, fixation and fusion can achieve remarkable curative effects in patients with traumatic spondylolisthesis of the axis including satisfactory anatomical reduction, and this strategy promotes the recovery of spinal cord nerve function.