Functional outcome in unstable Hangman's fracture managed with anterior approach: A prospective study

Jain, Vaibhav; Thakur, Manoj Kumar; Thakur, Amit; Sud, Sachin; Lal, Mukund; Madan, Ankit

doi:10.4103/jcvjs.jcvjs_113_17

Cited by 5 publications

(7 citation statements)

References 10 publications

(9 reference statements)

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“…Thus, the potential for surgery to avoid these problems has caused a general shift in literature to use surgery as a primary treatment option rather than deal with conservative treatment that has failed. 12,17,44,49,52 Various radically different surgical techniques may be employed via the anterior, posterior, or combined approach, and their indications, complications, and outcomes must be better understood to guide surgeons as surgical fixation becomes more commonly used in managing unstable hangman's fractures over conservative management. It remains widely accepted that type I fractures may be managed conservatively-only 14 patients of the 627 included in this review who were given a Levine-Edwards classification were type I, as they had excellent union rates nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Jain et al reported that in 44 patients who underwent ACDF, all had dysphagia that resolved spontaneously within 2 to 3 days. 49 This finding implies that this complication may be far more common than reported as different authors may use different thresholds of duration of dysphagia before reporting it as a complication.…”

Section: Complication Ratesmentioning

confidence: 96%

“…46,50,51 In the posterior approach, when threading pedicle screws across a fracture site, the screws compressed the fracture. 37,47 Jain et al, in describing the anterior approach, commented on whether screw purchase was unicortical or bicortical using unicortical locking screws 49 ; other authors describing both anterior and posterior approaches emphasized that great care was taken not to penetrate the far cortex when inserting screws. Authors used a variety of anterior cervical plates-of those specified, the most common was the Zephir plate; all were variable angle plates.…”

Section: Pre-and Intraoperative Techniquesmentioning

confidence: 99%

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Surgical Management of Hangman’s Fracture: A Systematic Review

2023

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Background: Hangman's fractures are bilateral fractures of the C2 pars interarticularis produced during hyperextension injuries. The Levine-Edwards classification divides these fractures into 4 categories determined by injury stability. While stable fracture patterns are typically managed conservatively, prolonged traction required in unstable fractures may be superseded by surgery in its practicality. Surgical approaches can be divided into anterior and posterior: the anterior approach allows access to the disc and is used for anterior cervical discectomy and fusion (ACDF); the posterior approach includes C2 direct pedicle screw (DPS), which preserves motion segments and may be done with a minimally invasive surgery (MIS) approach. Multilevel rod and screw fusion provide the strongest biomechanical fixation. This systematic review compares indications, complications, and functional outcomes of different approaches.Methods: A search of multiple databases with keywords "hangman fracture," "hangman's fracture," "axis fracture," and "C2 fracture" was conducted; articles were included if they described the surgical technique and included at least one of the primary outcomes: functional outcomes, complication rates, operation time, and blood loss.Results: A total of 1889 abstracts were screened, 137 full text articles were analyzed, and 36 articles were included, yielding a combined total of 627 patients. ACDF was preferred in unstable fracture patterns. Pre-and postoperative visual analog scale (VAS) scores fell in all groups, with MIS DPS producing the lowest VAS scores. Approaches had excellent neurological improvement and fusion rates. Reported complication rates were generally low; self-limiting dysphagia was most common in the anterior approach and higher volumes of blood loss occured with the posterior approach (255.9 mL in open posterior approach, 75.8 mL in MIS, and 64.3 mL in ACDF).Conclusion: All surgical methods of hangman's fracture fixation have their indications and advantages; surgeons should be equipped to perform all options. Anterior approaches may be preferred for their lower blood loss and access to the disc; however, MIS may improve outcomes in posterior approach.Clinical Relevance: This systematic review can assist spinal surgeons in the selection of the most appropriate surgical option for hangman's fracture and allow surgeons to inform patients of the risks and benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Complication Ratesmentioning

confidence: 96%

Section: Pre-and Intraoperative Techniquesmentioning

confidence: 99%

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Surgical Management of Hangman’s Fracture: A Systematic Review

2023

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“…in their series of 44 patients utilized the anterior C2-3 fixation alone, majority being type II with only 3 cases of type III Hangman's fracture. [ 25 ] The unequivocal supremacy of anterior approaches has been well recorded with regards to postoperative pain, neck mobility, and overall satisfaction with neck status in patients treated with the anterior approach. If decompression of the cord and nerve roots is required for neurological recovery, anterior C-3 corpectomy should be performed.…”

Section: Discussionmentioning

confidence: 99%

Saradhi's single stage, anterior sequential reduction utilizing C3 for type III hangman's fracture: A novel technique

Mudumba

Pavan

Alugolu

2022

J Craniovert Jun Spine

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Background: Levine Edward's Type III Hangman's fractures are highly unstable and in absence of level 1 evidence, the treatment is individualized. A longer cantilever beam can achieve not just reduction of highly displaced fragments but can also provide a stable construct without the need of global instrumentation. Objective: We extrapolated the surgical techniques of the long cantilever beam to this rare group of cohorts for anterior alone, sequential reduction utilizing C3 rather than sacrificing in a single sitting and single approach. Materials and Methods: This is a prospective observational study from 2015 to 2019, of all consecutive 10 patients diagnosed and treated as Type III Hangman's fracture in the Department of Neurosurgery. Clinical evaluation and pain scores were recorded in the preoperative assessment. Radiological investigations included plain roentgenograms in anterior-posterior and lateral views, magnetic resonance imaging, and computed tomography scan of the cervical spine. Preoperative cervical traction was placed in all cases for the achievement of facetal reduction. The high cervical extra-pharyngeal approach was utilized for discectomy, bone grafting, reduction, and sequential plating. Results: Complete reduction was achieved in all the cases and none required additional posterior surgery. There was a significant decrease in axial neck pain with complete fusion of the graft, and healing of fracture site. Conclusion: The anterior alone approach with a longer cantilever for primary internal stabilization is a technically safe and suitable option for unstable Type III Hangman's fracture.

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“…In the postoperative period, dysphagia is a very common complication associated with the anterior approach; however, it usually resolves spontaneously within 2–3 days [14]. Postoperative dysphagia may be due to endotracheal intubation, retraction of the oesophagus, and soft tissue inflammation.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Subaxial Spine Injuries Managed With 2-Level Anterior Cervical Corpectomy and Fusion: A Prospective Study

et al. 2018

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ObjectiveTo evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone–filled titanium mesh cage. MethodsThis study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. ResultsAccording to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12–48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. ConclusionTwo-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.

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Functional outcome in unstable Hangman's fracture managed with anterior approach: A prospective study

Cited by 5 publications

References 10 publications

Surgical Management of Hangman’s Fracture: A Systematic Review

Surgical Management of Hangman’s Fracture: A Systematic Review

Saradhi's single stage, anterior sequential reduction utilizing C3 for type III hangman's fracture: A novel technique

Functional Outcomes of Subaxial Spine Injuries Managed With 2-Level Anterior Cervical Corpectomy and Fusion: A Prospective Study

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