Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases

Coric, Domagoj; Wilson, John A.; Kelly, David L.

doi:10.3171/jns.1996.85.4.0550

Cited by 86 publications

(84 citation statements)

References 25 publications

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“…These injuries, characterized by minimally displaced fractures with a competent C2-C3 disc, are often effectively treated with a halo-vest orthosis or a hard cervical collar, with reported union rates approaching 100 % [38][39][40]. This is not unexpected, given the stability of the fracture in concert with a large surface area of apposed cancellous bone at the fracture site.…”

Section: Type I Fracturesmentioning

confidence: 99%

“…There remains debate regarding the most appropriate immobilization technique, hard collar versus halo. Coric et al presented a consecutive series of 64 patients, all treated with Philadelphia collars and all achieving union [38]. While halovests are generally safe, they are associated with minor complications such as pin-site infections and avoidance of a halo may be best when possible.…”

Section: Type I Fracturesmentioning

confidence: 99%

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Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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Fractures of the second cervical vertebra (C2, axis) are common in adult spine surgery. Those fractures occurring in younger adult patients are often associated with highenergy mechanism trauma, resulting in a "Hangman's Fracture." Management of these fractures is often successful with nonoperative means, though surgery may be needed in those fractures with greater displacement and injury to the C2-C3 disc. Older patients are more likely to sustain fractures of the odontoid process. The evidence supporting surgical management of these fractures is evolving, as there may be a mortality benefit to surgery. Regardless of treatment, longerterm mortality rates are high in this patient population, which should be discussed with the patient and family at the time of injury. Pediatric patients may suffer fractures of the axis, though differentiation of normal and pathologic findings is necessary and more difficult with the skeletally immature spine.

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Section: Type I Fracturesmentioning

confidence: 99%

Section: Type I Fracturesmentioning

confidence: 99%

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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“…Conservative treatment played a dominant role in the treatment of Hangman's fracture in the 1980s [1,7,15], and several researchers have reported a series of satisfactory cases using this technique. But some studies also have found disadvantages of conservative treatment, such as pseudarthrosis, anterior dislocation, angulation of C2 over C3, and recurrent axial pain [5,16]. In addition, long-term external immobilisation also produces much discomfort and inconvenience since the halo vest needs to be worn for a mean of three to six months [15,17].…”

Section: Discussionmentioning

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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“…Various surgical or nonsurgical treatments to achieve these aims have been described, but the optimal treatment remains in question. 2,9,23,24 Until quite recently, nonsurgical treatments were widely favored in the primary management of a hangman's fracture, even in the presence of instability.…”

mentioning

confidence: 99%

“…11 Studies have shown that anterior dislocation, angulation of C-2 over C-3, pseudarthrosis, and recurrent axial pain occur in about 60% of patients with Type II, IIa, and III fractures after conservative treatment. 2,9,23 The reported union rates following conservative management are 60% in Type II, 45% in Type IIa, and 35% in Type III hangman's fractures. 10 Vaccaro et al retrospectively investigated the early application of halo vest immobilization in a total of 31 hangman's fractures (27 Type II and 4 Type IIa).…”

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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Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases

Cited by 86 publications

References 25 publications

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

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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