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Chhikara M, Chahal D. Awake reduction of hangman's fracture: An era of dexmedetomidine. Trauma Case Rep 2024; 52:101046. [PMID: 38957170 PMCID: PMC11217754 DOI: 10.1016/j.tcr.2024.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/04/2024] Open
Abstract
Hangman's fracture is a kind of unstable cervical spine injury which should be treated promptly to avoid life threatening consequences. Advanced neurological monitoring is essential during surgical intrervention. Resource limited setting, where advanced monitors like SSEP and MEP are not available makes it challenging to assess proper reduction of cervical spine without neurological compromise. Dexmedetomidine proved to be very useful drug to assess the neurological status intra operatively by awake sedation.
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Affiliation(s)
- Monica Chhikara
- Department of Anaesthesiology, Pt B.D. Sharma PGIMS, Rohtak, India
| | - Davender Chahal
- Department of Anaesthesiology, Pt B.D. Sharma PGIMS, Rohtak, India
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Cai M, Wu Y, Ma R, Chen J, Chen Z, Deng C, Huang X, Ma X, Zou X. Comparison of Transoral Anterior Jefferson-Fracture Reduction Plate and Posterior Screw-Rod Fixation in C1-Ring Osteosynthesis for Unstable Atlas Fractures. Neurospine 2024; 21:544-554. [PMID: 38317544 PMCID: PMC11224759 DOI: 10.14245/ns.2347230.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To compare the clinical outcomes of transoral anterior Jefferson-fracture reduction plate (JeRP) and posterior screw rod (PSR) surgery for unstable atlas fractures via C1-ring osteosynthesis. METHODS From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at General Hospital of Southern Theatre Command of PLA; 30 males and 19 females were included. The visual analogue scale (VAS) score, Neck Disability Index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMD), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed. RESULTS Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (p < 0.05). CONCLUSION Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.
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Affiliation(s)
- Mandi Cai
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Yifeng Wu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Rencai Ma
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Junlin Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Zexing Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Chenfu Deng
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xinzhao Huang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xiangyang Ma
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xiaobao Zou
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
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Long Z, Yu H, Yang H, Guo M, Meng L, Yuan H, Xiang L, Wang Q. Biomedical analysis of four fixation systems in treatment of type II traumatic spondylolisthesis of the axis: a finite element analysis. Med Biol Eng Comput 2024; 62:843-852. [PMID: 38052881 DOI: 10.1007/s11517-023-02981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
This study aimed to compare the properties and safety of self-designed plates in type II traumatic spondylolisthesis of the axis with those of traditional devices via finite element (FE) analysis. We constructed a hangman's fracture FE model from the occipital bone (C0) level to the C3 level. Then, FE models were constructed for the following four fixation systems: an anterior cervical L-shaped plate with four vertebral screws (4-ACLP), or six screws (6-ACLP), an anterior cervical orion plate (ACOP), and a posterior fixation system. A preloaded compressive force of 50 N and a moment of 1.5 N·m were applied to each model under six working conditions. The mobility of the C2/3 segment decreased significantly in four fixation models. In the Mises stress cloud diagram, 4-ACLP showed a better stress distribution in both the bone graft and fixation system than 6-ACLP and ACOP. The resultant force of 4-ACLP was lower but higher than ACOP in axial force. Additionally, the cage in the 4-ACLP configuration experienced the highest stress in the six working conditions. Hence, this novel self-designed plate has the potential to mitigate the operational difficulties, provide sufficient stability, reduce the risk of plate or screw fractures, and improve bone fusion.
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Affiliation(s)
- Zuoyao Long
- General Hospital of Northern Theater Command, Shenyang, China
| | - Hailong Yu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Huifeng Yang
- General Hospital of Northern Theater Command, Shenyang, China
| | - Mingming Guo
- General Hospital of Northern Theater Command, Shenyang, China
| | - Lingzhi Meng
- General Hospital of Northern Theater Command, Shenyang, China
| | - Hong Yuan
- General Hospital of Northern Theater Command, Shenyang, China
| | - Liangbi Xiang
- General Hospital of Northern Theater Command, Shenyang, China.
| | - Qi Wang
- General Hospital of Northern Theater Command, Shenyang, China.
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Lu Q, Tang J, Xie W, Mei X, Kang H, Liu X, Xu F, Cai X. Anterior atlantoaxial motion preservation fixation technique for axis complex fractures (odontoid process with Hangman's fractures) and technique notes. Sci Rep 2024; 14:687. [PMID: 38182723 PMCID: PMC10770067 DOI: 10.1038/s41598-024-51367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
This study aims to investigate the feasibility and efficacy of anterior atlantoaxial motion preservation fixation (AMPF) in treating axis complex fractures involving the odontoid process fracture and Hangman's fractures with C2/3 instability. A retrospective study was conducted on eight patients who underwent AMPF for axis complex fractures at the General Hospital of Central Theater Command from February 2004 to October 2021. The types of axis injuries, reasons for injuries, surgery time, intraoperative blood loss, spinal cord injury classification (American Spinal Injury Association, ASIA), as well as complications and technical notes, were documented. This study included eight cases of type II Hangman's fracture, five cases of type II and three cases of type III odontoid process fracture. Five patients experienced traffic accidents, while three patients experienced falling injuries. All patients underwent AMPF surgery with an average intraoperative blood loss of 288.75 mL and a duration of 174.5 min. Two patients experienced dysphagia 1 month after surgery. The patients were followed up for an average of 15.63 months. One case improved from C to E in terms of neurological condition, three cases improved from D to E, and four cases remained at E. Bony fusion and Atlantoaxial Motion Preservation were successfully achieved for all eight patients. AMPF is a feasible and effective way for simultaneous odontoid process fracture and Hangman's fractures with C2/3 instability, while preserving atlantoaxial movement.
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Affiliation(s)
- Qilin Lu
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Jin Tang
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Wei Xie
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Xianzhong Mei
- Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Hui Kang
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Ximing Liu
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, South China Hospital of Shenzhen University, No. 1 Fuxin Road, Longgang District, Shenzhen, 518111, Guangdong, People's Republic of China.
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Lee S, Hur JW, Oh Y, An S, Yun GY, Ahn JM. Current Concepts in the Treatment of Traumatic C2 Vertebral Fracture : A Literature Review. J Korean Neurosurg Soc 2024; 67:6-13. [PMID: 37461838 PMCID: PMC10788552 DOI: 10.3340/jkns.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 01/17/2024] Open
Abstract
The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.
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Affiliation(s)
- Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Junseok W Hur
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Younggyu Oh
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gi-Yong Yun
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Pereira-Duarte M, Gagliardi M, Carazzo CA, Camino-Willhuber G, Gotfryd A, Rogers M, Guiroy A. Comparison of complication rates between anterior versus posterior approaches for treating unstable Hangman's fracture. A systematic review and meta-analysis. World Neurosurg X 2024; 21:100245. [PMID: 38221952 PMCID: PMC10787285 DOI: 10.1016/j.wnsx.2023.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 01/16/2024] Open
Abstract
Study design Systematic Review and Meta-analysis. Objective To compare the complication rates associated with anterior and posterior approaches for the surgical treatment of unstable hangman's fractures. Methods A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting complications of anterior versus posterior approaches for the treatment of unstable hangman's fractures. Results The search yielded 1163 papers from which 5 studies were fully included. One hundred fifteen (115) patients were operated on using an anterior approach versus 65 through a posterior approach. The average complication rates for the anterior and posterior approaches were 26.1 % and 13.8 %, respectively. No complications following the anterior approach required pharmacological or surgical intervention (Clavien-Dindo, Grade 1), while 88.9 % of complications following the posterior approach did (Clavien-Dindo, Grade 2). Conclusion No significant differences in the complication rates were found when comparing anterior versus posterior surgery for treating a C2 traumatic spondylolisthesis. However, most of the complications presented in the posterior surgery group were more severe.
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Affiliation(s)
- Matias Pereira-Duarte
- Adult Spine Unit, Hospital Italiano de Buenos Aires, Pte. Peron st. 4190, ZC 1199, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Gaston Camino-Willhuber
- Adult Spine Unit, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alberto Gotfryd
- Santa Casa of São Paulo Medical School and Hospitals, Sao Paulo, Brazil
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Yunde A, Furuya T, Orita S, Ohtori S, Yokogawa N, Nakashima H, Segi N, Funayama T, Ikegami S, Nakajima H, Watanabe K, Hasegawa T, Tonomura H, Terashima Y, Hashimoto K, Suzuki N, Uei H, Kiyasu K, Tominaga H, Sakai D, Kaito T, Inoue G, Okada S, Imagama S, Kato S. Hangman's Fracture in Geriatric Population: A Nationwide Multicenter Study in Japan. Global Spine J 2023:21925682231216925. [PMID: 37977098 DOI: 10.1177/21925682231216925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To investigate the treatments of the geriatric population with hangman's fractures using a multicenter database under the Japan Association of Spine Surgeons with Ambition (JASA). METHODS The multicenter database included data from 1512 patients. We employed the Levine and Edwards classification for categorizing hangman's fractures. The study incorporated epidemiological data, including the prevalence of hangman's fractures, patient age, and follow-up duration. Bony fusion rates and length of hospitalization were recorded for Type I and Type II fractures, and the degree of neurological impairment was assessed. RESULTS Hangman's fractures represented 62 cases, accounting for 7.4% of all cervical spine injuries. The patients had an average age of 76.6 ± 6.5 years, and the mean duration of follow-up was 21.5 ± 23.6 months. The study found that the bony fusion rate for hangman's fractures in the geriatric population was 88.9%. Surgical treatment was associated with a shorter hospitalization period for Type II fractures compared to conservative treatment. Thirteen cases of hangman's fractures in the geriatric population, accounting for 21%, were complicated by spinal cord injury. CONCLUSIONS This is the largest study to date on hangman's fractures in geriatric population ≥65 years. Type I and Type II fractures, according to the Levine and Edwards classification, had a bony fusion rate of up to 90%. In patients with Type II fractures, surgical treatment led to a shorter initial hospital stay. Geriatric patients are at risk of spinal cord injury due to hangman's fractures.
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Affiliation(s)
- Atsushi Yunde
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya UniversityGraduate School of Medicine, Nagoya, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya UniversityGraduate School of Medicine, Nagoya, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
- Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Hospital, Chiyoda-ku, Japan
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka UniversityGraduate School of Medicine, Suita, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka UniversityGraduate School of Medicine, Suita, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya UniversityGraduate School of Medicine, Nagoya, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
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Li S, Du J, Huang Y, Hao D, Zhao Z, Chang Z, Zhu J, Wang X, Duan Y, He B. Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine-Edward type IIA (postreduction) hangman fractures. Sci Rep 2023; 13:15934. [PMID: 37741877 PMCID: PMC10517983 DOI: 10.1038/s41598-023-43136-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/20/2023] [Indexed: 09/25/2023] Open
Abstract
The objective was to compare the clinical efficacy of percutaneous pedicle screw internal fixation with the aid of the TINAVI orthopaedic surgery robot with that of traditional open surgery for Levine-Edward type IIA (postreduction) hangman fractures and to evaluate the safety and efficacy of the TINAVI robot-assisted orthopaedic surgery procedure. The clinical data of 60 patients with Levine-Edward type IIA (postreduction) hangman fractures treated surgically from June 2015 to February 2022 were analysed retrospectively. Among these patients, 25 were treated with percutaneous pedicle screw fixation under TINAVI (the robot group), and 35 were treated with pedicle screw implantation assisted by a conventional C-arm X-ray machine (the traditional operation group). The pedicle screw placement grade was evaluated according to the Rampersaud scale. The correct rate of pedicle screw placement was calculated. The invasion of adjacent facet joints, VAS score (Visual Analogue Scale), NDI score (Neck Disability Index), SF-36 score (36-Item Short-Form Health Survey questionnaire), EQ-5D score (EuroQol-5 dimensions questionnaire) and operation-related data were recorded, and patients were followed up. All patients were followed up for an average of 15.0 ± 3.4 months. The accuracy of screw placement in the robot group was higher than that in the traditional operation group, while the rates of intraoperative blood loss and invasion of the facet joint were lower and the incision length and length of hospital stay were shorter. On the 3rd day after the operation, the VAS score in the robot group was significantly higher than that in the traditional operation group, but there was no significant difference in the NDI score. On the 3rd day after the operation, the SF-36 and EQ-5 questionnaire scores of the robot group were better than those of the traditional operation group. No complications occurred in any of the patients. Postoperative cervical X-ray showed that the cervical vertebra was stable, and there was no fracture, angle or displacement. Postoperative CT showed that all fractures healed, and the average healing time was 3.4 months. The treatment of Levine-Edward IIA (postrepositioning) hangman fractures with percutaneous pedicle fixation assisted by the TINAVI orthopaedic surgery robot can significantly improve screw placement accuracy with a low rate of invasion of the adjacent facet joint, a short operation time, a low bleeding rate, and high patient satisfaction. Although there are still many disadvantages, it still has good prospects for application.
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Affiliation(s)
- Shuai Li
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
- Medical College, Yan'an University, Yan'an, Shaanxi, China
| | - Jinpeng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Yunfei Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Zhigang Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Zhen Chang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Jingwen Zhu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Xiaodong Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Yongchao Duan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - BaoRong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China.
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Godlewski B, Dominiak M, Bebenek A. Revision Procedure After Surgery for Atypical Hangman's Fracture Primarily Performed Only from the Posterior Approach - An Attempt to Maintain Head Rotation: Case Report. Int Med Case Rep J 2023; 16:377-383. [PMID: 37366397 PMCID: PMC10290858 DOI: 10.2147/imcrj.s419321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Hangman's fracture, also known as traumatic spondylolisthesis of the axis, is defined as a bilateral fracture of the C2 pars interarticularis. In 1965, Schneider used this term to describe a pattern of similarities seen in fractures associated with judicial hangings. However, this fracture pattern is only observed in approximately 10% of injuries associated with hangings. Case Report We present a case of an atypical hangman's fracture caused by a headlong dive into a swimming pool and striking the pool's bottom. The patient had undergone surgery at another centre, where posterior C2-C3 stabilisation was performed. Due to the presence of screws in the C1-C2 joint spaces, the patient could not perform rotational movements of the head. Anterior stabilization to prevent C2 dislocation against C3 was also not performed, and appropriate spinal stability was not ensured. Our decision to reoperate was motivated, among other factors, by our intention to restore rotational head movements. The revision surgery was performed from both an anterior and posterior approach. After the surgery, the patient was able to rotate his head while maintaining cervical spine stability. The case presented here represents not only a unique example of an atypical C2 fracture but also highlights a fixation technique that provided the necessary stability for successful fusion. The utilized method restored functional rotational movement of the head, thus preserving the patient's quality of life, which is of paramount importance considering the patient's age. Conclusion The decision-making process regarding the technique for treating hangman's fractures, especially atypical fractures, should account for the patients' quality of life after the operation. The preservation of as much of the physiological range of motion as possible with maintained spinal stability should be the goal of therapy in every case.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed – St. Raphael Hospital, Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed – St. Raphael Hospital, Cracow, Poland
| | - Adam Bebenek
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed – St. Raphael Hospital, Cracow, Poland
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Liu Y, Li X, Chen T, Chen J, Zhu Y, Chu G, Yang H, Jiang W. Minimally invasive percutaneous new designed transpedicular lag-screw fixation for the management of Hangman fracture using O-arm-based navigation: a clinical study. BMC Musculoskelet Disord 2023; 24:494. [PMID: 37322465 DOI: 10.1186/s12891-023-06614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND To investigate the outcomes and safety of using minimally invasive percutaneous new transpedicular lag-screw fixation with intraoperative, full rotation, three-dimensional image (O-arm)-based navigation for the management of Hangman fracture. METHODS Twenty-two patients with Hangman fracture were treated with minimally invasive percutaneous new transpedicular lag-screws using intraoperative, full rotation, and three-dimensional image (O-arm)-based navigation. The preoperative and postoperative conditions of the patients were evaluated according to the ASIA (American Spinal Injury Association) scale. The patient's VAS (visual analog scale) scores before and after surgery, operation time, cervical vertebral activity, intervertebral angle and bone healing were recorded and collected, and repeated measures analysis of variance was used for statistical analysis. RESULTS All patients were satisfactorily repositioned after surgery, and the VAS scores for neck pain were significantly lower than those before surgery on the first day and at 1 month, 3 months and the last follow-up (P < 0.001). According to the ASIA scale, four patients recovered from preoperative grade D to postoperative grade E. Bony fusion was achieved for all cases, and the range of neck rotation was restored to normal at the last follow-up. The post-surgery angular displacement (AD) demonstrated the stability of C2-3 after our new screw fixation for the treatment of Hangman fracture. CONCLUSIONS Minimally invasive percutaneous new transpedicular lag-screw fixation using intraoperative, full rotation, three-dimensional image (O-arm)-based navigation achieved satisfactory clinical results with the advantages of immediate stability, safety and effectivity. We suggest that it is a reliable and advanced technique for the management of Hangman fracture.
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Affiliation(s)
- Yijie Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Xuefeng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Tangyiheng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Jie Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Yi Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China.
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China.
| | - Weimin Jiang
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, 9 Chongwen Road, Suzhou, 215124, Jiangsu Province, China.
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Tumbiolo S, Lombardo MC, Porcaro S, Adorno A, La Fata G, Tiziana C, Brunasso L, Paolini S, Visocchi M, Iacopino DG, Maugeri R. New Trend in Craniovertebral Junction Surgical Strategy: Technical Note for the Treatment of Hangman's Fractures Through a Minimally Invasive Approach. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:283-289. [PMID: 38153483 DOI: 10.1007/978-3-031-36084-8_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The reduction, stabilization, and maintenance of alignment are the main goals in the surgical treatment of unstable hangman's fractures. The choice of the surgical strategy remains poorly standardized; anterior and/or posterior fusion could be performed; and none of the available clinical studies in the literature have shown significant differences in outcomes or complication rates. Vertebral anatomy, age, comorbidities, patient factors, and surgical experience may guide the treatment choice. METHODS We present a case of a polytraumatized young woman with an unstable hangman's fracture type II, according to Levine-Edwards classification. We treated the fracture by using a plate with four holes to fix C2-C3 without discectomy and body fusion. RESULTS We performed a small incision, such as those used for the fixation of odontoid screws, where the working angle allowed us to easily and quickly position the plate by using a minimally invasive approach. CONCLUSION The stabilization alone, without discectomy and body fusion with the cage, in the same way favored the natural healing of the bone fracture. In our opinion, in some select cases, fixation of C2-C3 alone through a minimally invasive approach allows for bone healing with fewer risks and an easier surgery.
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Affiliation(s)
- Silvana Tumbiolo
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Maria Cristina Lombardo
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Simona Porcaro
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Alessandro Adorno
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Giuseppe La Fata
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Costanzo Tiziana
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | - Saverio Paolini
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
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12
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Traumatic spondylolisthesis of axis: clinical and imaging experience at a level one trauma center. Emerg Radiol 2022; 29:715-722. [PMID: 35543854 DOI: 10.1007/s10140-022-02041-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Traumatic spondylolisthesis of the axis (TSA) with bilateral pars interarticularis fracture (a pattern also known as Hangman's fractures) accounts for 4-5% of all cervical fractures. Various classification systems have been described to assist therapeutic decision-making. The goal is to reassess the utility of these classifications for treatment strategy and evaluate additional imaging associations. METHODS This is an IRB approved, retrospective analysis of patients with imaging diagnosis of TSA from 2016 to 2019. Consensus reads were performed classifying TSA into various Levine and Edwards subtypes and typical vs. atypical fractures. Other imaging findings such as additional cervical fractures, traumatic brain injury, spinal cord injury, and vertebral artery injury were recorded. Treatment strategy and outcome were reviewed from clinical charts. Fisher exact test was used for statistical analysis. RESULTS A total of 58 patients were included, with a mean age of 62.7 ± 25 years, and male to female ratio of 1:1.2. Motor vehicle collision was the most common cause of TSA. Type I and III injuries were the most and the least common injuries, respectively. Patients with type I injuries were found to have good healing rates with conservative management (p < 0.001) while type IIa and III injuries were managed with surgical stabilization (p = 0.04 and p = 0.01, respectively). No statistical difference was observed in the treatment strategy for type II fractures (p = 0.12) and its prediction of the associated injuries. Atypical fractures were not found to have a higher incidence of SCI (p = 0.31). A further analysis revealed significantly higher-grade vertebral artery injuries (grades III and IV according to Biffl grading) in patients with type IIa and III injuries (p = 0.001) and an 11-fold increased risk of TBI compared to type I and type II fractures (p = 0.013). CONCLUSION TSA fracture types were not associated with any clinical outcome. Levine and Edwards type II classification itself is not enough to guide the treatment plan and does not account for associated injuries. Additional imaging markers may be needed.
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13
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Chen YF, Luan GN, Li XJ, Peng Y, Li TF, Zhang HX, Li JY, Ma S, Li SL, Xue J, Du JJ. C2-C3 Anterior Cervical Diskectomy and Fusion for Hangman's Fractures with C2 Posterior Dislocation: Technical Notes. World Neurosurg 2021; 158:210-215. [PMID: 34838763 DOI: 10.1016/j.wneu.2021.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The overwhelming majority of hangman's fractures cause anterior dislocation of C2. Hangman's fracture with C2 posterior dislocation is extremely rare; only 1 pediatric case was reported in 2018 to date. This kind of injury cannot be cataloged using current classification schemes, and no established treatment recommendations exist. The purpose of this article is to report a rare case of a hangman's fracture with C2 posterior dislocation, which does not fit into existing classification systems and discuss management technical notes to avoid pitfalls. METHODS We describe this case, review relevant literature, and share our experience. RESULTS A 31-year-old male sustained a hangman's fracture with C2 posterior dislocation after he fell into a 50-cm deep roadside ditch when riding a motorcycle. Radiograph and computed tomography on admission showed fractures through both pars of C2 and C2 posterior dislocation. Magnetic resonance imaging on admission showed high T2-weighted signal intensity of cervical spinal cord and compression of the cervical spinal cord by posterior dislocation of the C2 vertebral body. A C2-3 anterior cervical diskectomy and fusion was performed. At 6 months after operation, bony fusion was achieved and magnetic resonance imaging showed the T2-weighted signal hyperintensity of cervical spinal cord before surgery disappeared. CONCLUSIONS C2-C3 anterior cervical diskectomy and fusion is recommended for hangman's fractures with C2 posterior dislocation. Traction before surgery is not recommended.
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Affiliation(s)
- Yu-Fei Chen
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Guan-Nan Luan
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiao-Jie Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Ye Peng
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Teng-Fei Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Hong-Xing Zhang
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Jing-Yuan Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Shuang Ma
- Department of Orthopaedics, Sanmenxia Yellow River Hospital, Henan, People's Republic of China
| | - Song-Lin Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Jing Xue
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Jun-Jie Du
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China.
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Abstract
Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in automobile technology, resuscitation techniques, and diagnostic modalities. The leading injury mechanisms are motor vehicle crashes, falls from height, and sports-related events. Current treatment with urgent rigid posterior fixation of the occiput to the cervical spine has resulted in a substantial reduction in management delays expedites treatment of CCJ injuries. Within CCJ injuries, there is a spectrum of instability, ranging from isolated nondisplaced occipital condyle fractures treated nonoperatively to highly unstable injuries with severely distracted craniocervical dissociation. Despite the evolution of understanding and improvement in the management of cases regarding catastrophic failure to diagnose, subsequent neurologic deterioration still occurs even in experienced trauma centers. The purpose of this article is to review the injuries that occur at the CCJ with the accompanying anatomy, presentation, imaging, classification, management, and outcomes.
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Affiliation(s)
- Catherine Olinger
- Harborview Medical Center, University of Washington Department of Orthopaedics and Sports Medicine, 908 Jefferson Street, Fifth Floor, Seattle, WA, USA.
| | - Richard Bransford
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Spine Fellowship Program, University of Washington Department of Orthopaedics and Sports Medicine, 908 Jefferson Street, Fifth Floor, Seattle, WA, USA
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Basankin IV, Giulzatyan АА, Nesterenko PB, Bagaudinov АB, Tayurski DА, Mukhanov МL. Experience of Using Transpedicular Osteosynthesis in Traumatic Spondylolisthesis of the Axis. Sovrem Tekhnologii Med 2021; 13:47-53. [PMID: 35265349 PMCID: PMC8858407 DOI: 10.17691/stm2021.13.5.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to assess the efficacy and safety of direct posterior transpedicular osteosynthesis in traumatic spondylolisthesis of C2 vertebra. Materials and Methods The present study is an observational retrospective analysis of the results of surgical treatment of 19 patients operated on in 2014-2020 using the posterior transpedicular osteosynthesis technique with Herbert's compression screws for a Hangman's fracture type II according to Levine-Edwards classification. After the operation, the follow-up period lasted for 22 [10; 36] months. Results The study group of patients (n=19) made 2.48% of all patients operated on for traumatic injury of the cervical spine (n=766) in the period from 2014 to 2020. In all cases, the surgical treatment was successful; there were no intraoperative complications in the form of damage to the vascular and nerve structures. The average duration of surgery was 70.8±24.5 min, and intraoperative blood loss was 92.9±41.8 ml. The length of hospitalization stay was 7 [5; 17] days. On the postoperative CT scans, no significant screw malposition (>2 mm) was found. Conclusion Transpedicular osteosynthesis with compression screws in C2 traumatic spondylolisthesis is a safe and sparing operation with a short duration and insignificant blood loss. Thorough preoperative planning and knowledge of the anatomic landmarks make it possible to perform this operation effectively under the C-arm X-ray system control without any navigation system.
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Affiliation(s)
- I V Basankin
- Head of Neurosurgical Unit No.3 Scientific Research Institute - Ochapovsky Regional Clinical Hospital No.1, Ministry of Health of Krasnodar Region, 167, 1 Maya St., Krasnodar, 350086, Russia
| | - А А Giulzatyan
- Neurosurgeon Scientific Research Institute - Ochapovsky Regional Clinical Hospital No.1, Ministry of Health of Krasnodar Region, 167, 1 Maya St., Krasnodar, 350086, Russia
| | - P B Nesterenko
- Orthopedist Scientific Research Institute - Ochapovsky Regional Clinical Hospital No.1, Ministry of Health of Krasnodar Region, 167, 1 Maya St., Krasnodar, 350086, Russia
| | - А B Bagaudinov
- Neurosurgeon Scientific Research Institute - Ochapovsky Regional Clinical Hospital No.1, Ministry of Health of Krasnodar Region, 167, 1 Maya St., Krasnodar, 350086, Russia
| | - D А Tayurski
- Student, Medical Faculty Kuban State Medical University, 4 M. Sedina St., Krasnodar, 350063, Russia
| | - М L Mukhanov
- Assistant, Department of Orthopedics, Traumatology and Military Field Surgery Kuban State Medical University, 4 M. Sedina St., Krasnodar, 350063, Russia
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16
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Abstract
STUDY DESIGN Review article. OBJECTIVE A review and update of the treatment of Hangman's fractures including the indications for both nonoperative and operative treatment of typical and atypical fractures. SUMMARY OF BACKGROUND DATA Hangman's fractures are the second most common fracture pattern of the C2 vertebrae following odontoid fractures. Many of the stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIa and III fractures require surgical stabilization. METHODS A review of the literature. RESULTS The clinical and radiographic outcomes of the treatment of Hangman's fractures lend a good overall prognosis when the correct diagnosis is made. The nonoperative treatment of stable type I and II fractures with external immobilization leads to excellent long-term outcomes as does the operative treatment of the unstable type IIa and III fractures. CONCLUSIONS Hangman's fractures can be classified as stable (type I and most II) or unstable (type IIa and III) and the optimal treatment depends upon this distinction. Stable injuries do well with rigid immobilization and rarely require operative intervention. In contrast, unstable injuries do poorly if treated nonoperatively but do well with surgical intervention. When treating atypical Hangman's variants, great vigilance and close clinical observation is paramount if nonoperative treatment is indicated given the potential for neurological compression in this fracture pattern. Properly identifying and treating these injuries represents an opportunity for the spine surgeon to optimize patient outcomes.
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17
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Martinez-Perez R, Joswig H, Rayo N, Moscote-Salazar LR, Gomez PA. Subacute Management of a Dislocated Hangman Fracture, What Happens Afterwards? A Long-Term Follow Up. Neurol India 2020; 68:959-960. [PMID: 32859859 DOI: 10.4103/0028-3886.293491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rafael Martinez-Perez
- Division of Neurosurgery, The Ohio State University, Columbus, OH, USA; Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Holger Joswig
- Department of Neurosurgery, Ernst von Bergsmann Hospital, Potsdam, Germany
| | - Natalia Rayo
- Department of Biology, Western University, London, Canada
| | | | - Pedro A Gomez
- Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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