Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Xu, Hao; Zhao, Jie; Yuan, Jiandong

doi:10.1007/s00264-008-0658-0

Cited by 35 publications

(16 citation statements)

References 10 publications

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“…[8][9][10] No studies so far (to the best of our knowledge) accurately describe the precise anatomical location and frequency of the fracture lines in this injury. Therefore, the objective of our study was to assess the anatomy of hangman's fracture with respect to location, pattern, extent and symmetry and to describe distinct fracture patterns that hopefully will replace the general [(neural arch fracture)] term.…”

Section: Introductionmentioning

confidence: 99%

Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims

Menon

Taif

2016

BJR

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Section: Introductionmentioning

confidence: 99%

Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims

Menon

Taif

2016

BJR

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“…Thus, it is worth considering whether the anterior approach may become an alternative to the posterior approach. Anterior fusion with iliac graft and plates at C2-3 has been confirmed as an effective management for Hangman's fracture [12,23]. Importantly, complications related with the anterior approach including injury to the hypoglossal nerve and superior laryngeal nerve are no longer the hindrances for proficient and experienced surgeons.…”

Section: Discussionmentioning

confidence: 94%

“…However, the pathogenesis of this special fracture often causes C2-C3 disc hernia and spinal cord compression. Some other surgeons choose the anterior approach [12]. But this motionpreserving procedure excluding the C2-3 segment is not appropriate for fractures in which spinal cord compression comes from the posterosuperior part of C3 vertebral body and the intervertebral disc injury at the C2-3 level.…”

Section: Introductionmentioning

confidence: 99%

Anterior C3 corpectomy and fusion for complex Hangman’s fractures

Ma¹,

Yuan

Wang

et al. 2012

International Orthopaedics (SICOT)

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“…7,23 However, a surgical intervention may ultimately be needed if conservative treatment results in spinal column instability, poor alignment, or other condition that generates persistent neck pain. 25,27 For this reason, surgery is gaining favor as a firstline treatment for certain subtypes of hangman's fracture. Methods of surgical stabilization include anterior surgery such as anterior cervical discectomy and fusion (ACDF) at C2-3; posterior surgeries such as C-2 transpedicular screw fixation, C2-3 fixation, extensive arthrodesis from C-1 to C-3, and occipitocervical fixation; and surgery by both anterior and posterior approaches.…”

mentioning

confidence: 99%

Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures

Shin

Kim

Cho

et al. 2013

SPI

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Object Several controversial issues arise in the management of unstable hangman's fractures. Some surgeons perform external reduction and immobilize the patient's neck in a halo vest, while others perform surgical reduction and internal fixation. The nonsurgical treatments with rigid collar or halo vest immobilization present problems, including nonunion, pseudarthrosis, skull fracture, and scalp laceration and may also fail to achieve anatomical realignment of the local C2–3 kyphosis. With recent advances in surgical technique and technology, surgical intervention is increasingly performed as the primary treatment in high cervical fractures. The outcomes of such surgeries are often superior to those of conservative treatment. The authors propose that surgical intervention as a primary management for hangman's fracture may avoid risks inherent in conservative management when severe circumferential discoligamentous instability is present and may reduce the risk of catastrophic results at the fracture site. The purposes of this study were to assess fracture healing following expedient reduction and surgical fixation and to propose a guideline for treatment of unstable hangman's fractures. Methods From April 2006 to December 2011, the authors treated 105 patients with high cervical fractures. This study included 23 (21.9%) of these patients (15 men and 8 women; mean age 46.4 years) with Type II, IIa, and III hangman's fractures according to the Levine and Edwards classification. The patient's age, sex, mechanism of injury, associated injuries, neurological status, and complications were ascertained. The authors retrospectively assessed the clinical outcome (Neck Disability Index), radiological findings (disc height, translation, and angulation), and bony healing. Results The average follow-up period was 28.9 months (range 12–63.2 months). The overall average Neck Disability Index score at the time of this study was 6.6 ± 2.3. The average duration of hospitalization was 20.3 days, and fusion was achieved in all cases by 14.8 ± 1.6 weeks after surgery, as demonstrated on dynamic radiographs and cervical 3D CT scans. The mean pretreatment translation was 6.9 ± 3.2 mm, and the mean postoperative translation was 1.6 ± 1.8 mm (mean reduction 5.2 ± 3.1 mm). The initial angulation was 4.7° ± 5.3° and the postoperative angulation was 2.5° ± 1.8° (mean reduction 6.1° ± 5.3°). The preoperative and postoperative values for translation and angulation differed significantly (p < 0.05). The overall C2–3 disc height was 6.7 ± 1.2 mm preoperatively, whereas 3 months after surgery it was 6.4 ± 1.1 mm. These values did not differ significantly (p = 0.0963). Conclusions The authors observed effective reduction and bony healing in cases of unstable hangman's fractures after fixation, and all patients experienced favorable clinical outcomes with neck pain improvement. The protocols allowed for physiological reconstruction of the fractured deformities and avoided external fixation. The authors suggest that posterior reduction and screw fixation should be used as a primary treatment to promote stability of hangman's fracture in the presence of discoligamentous instability or combined fractures.

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Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Abstract: Between 1999 and 2004, 28 patients (average age: 41, range: 18-70 years) with unstable hangman's fracture underwent anterior discectomy and fusion with internal fixation at our unit. According to the LevineEdwards classification, all cases were unstable with type II

Cited by 35 publications

References 10 publications

Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims

Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims

Anterior C3 corpectomy and fusion for complex Hangman’s fractures

Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures

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