Management of Typical and Atypical Hangman's Fractures

Al-Mahfoudh, Rafid; Beagrie, Christopher; Woolley, Ele; Zakaria, Rasheed; Radon, Mark; Clark, Simon; Pillay, Robin; Wilby, Martin

doi:10.1055/s-0035-1563404

Cited by 62 publications

(70 citation statements)

References 49 publications

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“…This differentiated approach to this type of injury is also advocated by others. 1,11,17 The halo vest leads to an improved immobilization of the upper cervical spine and enables fracture reduction. Halo therapy and surgical stabilization are therefore regarded as complementary for unstable L-E Type II injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Halo therapy and surgical stabilization are therefore regarded as complementary for unstable L-E Type II injuries. 1,17 Alternative operative procedures are the posterior stabilization of C2/3, and in particular the anterior intercorporal fusion of C2/3 with plating. The open posterior procedures have several disadvantages compared with direct lag screw osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neuronavigation and 3D fluoroscopy–guided lag screw reduction and osteosynthesis for traumatic spondylolistheses of the axis: a path worth exploring?

Zeden

Müller

Refaee

et al. 2017

Neurosurgical Focus

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OBJECTIVEIn traumatic spondylolistheses of the axis, there is a marked heterogeneity of the observed injury patterns, with a wide range of the severity—from stable fractures, which can be treated conservatively with very good success, to highly unstable fractures, which should be treated surgically. A number of classification systems have been devised to assess the instability of the injuries and to derive a corresponding therapy recommendation. In particular, the results and recommendations regarding medium-severity cases are still inconclusive. Minimally invasive percutaneous procedures performed using modern techniques such as 3D fluoroscopy and neuronavigation have the potential for improvements in the therapeutic outcome and procedural morbidity against open surgical procedures and conservative therapy.METHODSA minimally invasive method using 3D fluoroscopy and neuronavigation for percutaneous lag screw osteosynthesis of the pars interarticularis was performed in 12 patients with a Levine-Edwards Type II fracture. Ten patients had an isolated hangman’s fracture and 2 patients had an additional odontoid fracture of the axis (Type II according to the Anderson and D’Alonzo classification system). Complications, operating parameters, screw positions, and bony fusion were evaluated for the description and evaluation of the technique.RESULTSIn 6 men and 6 women, percutaneous lag screw osteosynthesis was performed successfully. Correct placement could be verified postoperatively for all inserted screws. In the case series, nonunion was not observed. In all patients with a complete follow-up, a bony fusion, an intact vertebral alignment, and no deformity could be detected on CT scans obtained after 3 months.CONCLUSIONSThe percutaneous pars interarticularis lag screw osteosynthesis is a minimally invasive and mobility-preserving surgical technique. Its advantages over alternative methods are its minimal invasiveness, a shortened treatment time, and high fusion rates. The benefits are offset by the risk of injury to the vertebral arteries. The lag screw osteosynthesis is only possible with Levine-Edwards Type II fractures, because the intervertebral joints to C-3 are functionally preserved. A further development and evaluation of the operative technique as well as comparison with conservative and alternative surgical treatment options are deemed necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neuronavigation and 3D fluoroscopy–guided lag screw reduction and osteosynthesis for traumatic spondylolistheses of the axis: a path worth exploring?

Zeden

Müller

Refaee

et al. 2017

Neurosurgical Focus

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“…The fracture comprises 4% of all adult cervical fractures, and over 22% of all axis fractures in adults [4,12] . It is rare in the pediatric population, where only 1-4% of all spinal injuries occur, and only 1.5% of all pediatric trauma results in cervical spine injury [12,13] .…”

Section: Pediatric Prevalencementioning

confidence: 99%

“…These authors described the lesion as an avulsion of the neural arch of C 2 along the stress points of the weakest elements, i.e. the pars articularis, and concomitant anterolisthesis of the vertebral body of C 2 , usually sparing the odontoid process [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Pediatric Hangman's Fracture: A Comprehensive Review

Montalbano¹,

Fisahn²,

Loukas³

et al. 2017

Pediatr Neurosurg

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Purpose: Over 170 years ago, traumatic spondylolisthesis of the axis or hangman's fracture was described. Most descriptions of this entity have focused on adult presentations. Methods: We review the literature on pediatric cases of hangman's fracture emphasizing the embryological as well as presentation aspects. Results: The majority of cervical spine fractures in children occur at C₁ and C₂ vertebrae. A normal anterolisthesis of C₂ can be seen in younger children and can mimic the anterolisthesis seen after traumatic spondylolisthesis. Conclusions: Traumatic spondylolisthesis of the axis in children requires further investigation due to the current emphasis in the literature on adult clinical findings and diagnostic challenges from the developmental immaturity of the pediatric skeleton.

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“…2,3 however, at times there can be fracture with insignifi cant displacement or listhesis which can be managed conservatively with rigid cervical collar. …”

Section: Figure 1: Radiological Images A) Preoperative Dynamic X-raymentioning

confidence: 99%