A New Minimally Invasive Technique for Primary Unstable C2 Spondylolysis in an 8-Year-Old Child: A Case Report and Review of the Literature

Percutaneous Fixation of Levine-Edwards Type II Hangman's Fractures Under the Guidance of an Orthopedic Robot

There is no consensus regarding the optimal treatment for unstable hangman's fractures. Conservative treatment, although time-consuming and associated with complications such as nonunion, neck stiffness, and pseudarthrosis formation, is still preferred by many surgeons. With the development of minimally invasive techniques, surgical treatment is trending in recent years. We have proposed a minimally invasive, robot-assisted technique for the treatment of Levine-Edwards (L-E) type II hangman's fractures; this could improve the patients' quality of life. Five patients with L-E type II hangman's fractures were treated operatively initially. After closed reduction, the C2 pedicle screws were inserted percutaneously with the guidance of the orthopedic surgical robot. The positions of pedicle screws were verified by intraoperative 3-dimensional C-arm fluoroscopy. Regular follow-ups were performed to evaluate the radiological and functional outcomes. Postoperatively, all the fractures have healed with an average healing time of 3.5 months, the functional outcomes were satisfactory at last follow-up, and there was no neurovascular injury associated with this technique. The 3D-fluoroscopy-based, robot-assisted C2 pedicle screw fixation is a safe, precise, and feasible method for the initial treatment of L-E type II hangman's fractures. [Orthopedics. 2023;46(1):59-63.].

Direct trans-pedicular screw fixation for atypical hangman's fracture: A minimally invasive technique using the tubular retractor system

The ideal treatment strategy of atypical hangman's fracture (AHF) is debatable. If surgical treatment is needed, direct trans-pedicular fixation technique is advantageous in that it stabilizes the fracture site and spares adjacent motion segments. The authors describe relatively simple and minimally invasive technique using the tubular retractor system (TRS) for surgical treatment of AHF. Trans-pedicular screw fixation using the TRS was performed in seven patients with AHF. This technique was facilitated by using intraoperative fluoroscopy and a surgical microscope. Rigid cervical collar was used for 4 weeks, postoperatively. To evaluate postoperative radiological outcomes, cervical computed tomography (CT) was performed at postoperative 6 months. The clinical outcomes, including visual analog scale and neck motion, were evaluated. In surgical outcomes, no intraoperative neuro-vascular injury or postoperative complications occurred. For all patients, dynamic radiographs and CT images demonstrated a stable construct. Clinical examination also showed satisfactory pain relief and restoration of the full range of motion in the neck. Direct trans-pedicular screw fixation using the TRS for AHF appears to be safe and effective. This technique permits less skin incision and muscle dissection with good postoperative recovery. This report serves as a preliminary study and may be a surgical option for minimally invasive direct repair.