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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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Prasad GL. Traumatic irreducible non-Hangman's type bilateral C2-C3 high-grade facet dislocation: technical nuance. Br J Neurosurg 2023; 37:1387-1390. [PMID: 33263442 DOI: 10.1080/02688697.2020.1854683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
Majority of C2-C3 vertebral dislocations occur as in combination with bilateral pars fractures, also known as Hangman's fractures. Isolated C2-C3 facet dislocation without any associated C2 fracture is a very rare injury. One such case has been presented in this report. A 29-year male was involved in a road traffic accident (RTA) after which he developed midline neck pain. Following a minor neck manipulation at a hair salon 15 days after the RTA, his neck pain worsened and he developed quadriparesis. Imaging at the time of admission showed bilateral high-grade C2-C3 facet dislocations without any associated fracture of C2 vertebra. Due to non-reduction of the dislocation with skeletal traction, surgery was contemplated. Intraoperatively, the C2-C3 joint spaces were opened but only partial reduction could be achieved. Complete reduction was achieved only after opening of the C1-C2 joints was performed. Later, C2-C4 screw-rod constructs were placed. Patient achieved good outcome with resolution of symptoms. This report concludes that, in cases of delayed presentation of irreducible C2-C3 bilateral facet dislocations and non-reducibility by skeletal traction, opening of the C1-2 joints may need to be performed in addition to the C2-C3 joint spaces, in order to achieve complete reduction.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Teuber H, Halvachizadeh S, Muthirakalayil M, Yin L, Eisenkrein H, Hildebrand F, Kobbe P, Sprengel K, Mica L, Alkadhi H, Pape HC, Pfeifer R. Can radiologic parameters used to detect cervical spinal instability be used in patients with ankylosing spondylitis? Eur J Med Res 2023; 28:97. [PMID: 36841781 PMCID: PMC9960164 DOI: 10.1186/s40001-023-01052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Cervical spinal instability can be difficult to detect in the shock room setting even with the utilization of computed tomography (CT) scans. This may be especially true in patients with cervical degenerative disease, such as ankylosing spondylitis (AS). The purpose of this study was to investigate the influence AS has on various radiologic parameters used to detect traumatic and degenerative instability of the cervical spine, to assess if CT imaging in the shock room is diagnostically appropriate in this patient population. METHODS A matched, case-control retrospective analysis of patients with AS and controls without AS admitted at two level-1 trauma centers was performed. All patients were admitted via shock room and received a polytrauma CT. Twenty-four CT parameters of atlanto-occipital dislocation/instability, traumatic and degenerative spondylolisthesis, basilar invagination, and prevertebral soft tissue swelling were assessed. Since the study was assessing normal values, study patients were included if they had no injury to the cervical spine. Study patients were matched by age and sex. RESULTS A total of 78 patients were included (AS group, n = 39; control group, n = 39). The evaluated cervical radiologic parameters were largely within normal limits and showed no significant clinical or morphologic differences between the two groups. CONCLUSION In this analysis, CT measurements pertaining to various cervical pathologies were not different between patients with and without AS. Parameters to assess for atlanto-occipital dislocation/instability, spondylolisthesis, or basilar invagination in the trauma setting may reliably be used in patients with AS.
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Affiliation(s)
- Henrik Teuber
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- grid.7400.30000 0004 1937 0650Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melvin Muthirakalayil
- grid.7400.30000 0004 1937 0650Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luxu Yin
- grid.1957.a0000 0001 0728 696XDepartment of Orthopedics Trauma Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Harry Eisenkrein
- grid.1957.a0000 0001 0728 696XDepartment of Orthopedics Trauma Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Frank Hildebrand
- grid.1957.a0000 0001 0728 696XDepartment of Orthopedics Trauma Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Philipp Kobbe
- grid.1957.a0000 0001 0728 696XDepartment of Orthopedics Trauma Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Kai Sprengel
- grid.7400.30000 0004 1937 0650Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ladislav Mica
- grid.7400.30000 0004 1937 0650Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- grid.7400.30000 0004 1937 0650Department of Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- grid.7400.30000 0004 1937 0650Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roman Pfeifer
- grid.7400.30000 0004 1937 0650Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Alugolu R, Mudumba V, Pavan S. Saradhi's single stage, anterior sequential reduction utilizing C3 for type III hangman's fracture: A novel technique. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:80-84. [PMID: 35386244 PMCID: PMC8978851 DOI: 10.4103/jcvjs.jcvjs_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022] Open
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Liu Y, Zhu Y, Li X, Chen J, Yang S, Yang H, Jiang W. A new transpedicular lag screw fixation for treatment of unstable Hangman's fracture: a minimum 2-year follow-up study. J Orthop Surg Res 2020; 15:372. [PMID: 32873313 PMCID: PMC7466811 DOI: 10.1186/s13018-020-01911-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new C2 transpedicular lag screw designed by our team has been used in human cadaver spines for biomechanical testing, and the results showed that the biomechanical properties of the new C2 transpedicular lag screw were better than ordinary screws. The objective of this study is to analyze the clinical efficacy and safety of the new C2 transpedicular lag screw fixation for the treatment of unstable Hangman's fracture. METHODS From March 2013 to June 2017, 25 patients who had unstable Hangman's fractures were operated on with a new C2 transpedicular lag screw fixation. The patients included 18 males and 7 females whose ages ranged from 31 to 62 years (average 45.4 ± 9.3 years). The cause of the injury was a traffic accident in 17 patients and a fall from height in 8 patients. Other associated lesions included rupture of the spleen (1 patient) and rib fractures (2 patients). According to the Levine-Edwards classification, 17 patients were type II and 8 patients were type IIA, and according to the Frankel Neurological Performance scale, 8 cases and 17 cases were graded as spinal cord injury D and E, respectively. Twenty-three cases received bilateral screw fixation, and 2 cases had unilateral screw fixation because another pedicle was chipped. The whole procedure was accomplished with monitoring by "C"-arm fluoroscopy. RESULTS The mean follow-up time was 36 ± 12 months and ranged from 24 to 60 months. No obvious symptomatic or radiologic postoperative complications were found during the follow-up period. Six cases were restored from D to E while 2 cases remained D according to the American Spinal Injury Association (ASIA) grade. Pre- and postoperative visual analogue scale (VAS) and Neck Disability Index (NDI) were statistically different (P < 0.001). Osseous union was achieved in all cases, and the range of cervical motion recovered to the normal level up to the last follow-up. CONCLUSIONS The primary clinical and radiographic efficacies of a new C2 transpedicular lag screw fixation for the treatment of unstable Hangman's fracture were satisfactory. This approach could be considered a simple, effective, reliable, and economic surgical method for managing unstable Hangman's fractures.
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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
| | - Yi Zhu
- 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
| | - Jie Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Sen Yang
- 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, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China.
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Kong W, Yang X, Li Z, Hu B, Song Y. Analysis of the Cervical Sagittal Alignment in Patients with Unstable Hangman Fracture Under C2∼3 Anterior Discectomy and Fusion. World Neurosurg 2020; 137:e1-e8. [DOI: 10.1016/j.wneu.2019.08.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 12/17/2022]
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8
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Wolan-Nieroda A, Maciejczak A, Przysada G, Kużdżał A, Magoń G, Czarnota M, Drużbicki M, Guzik A. Assessment of cervical range of motion in patients after axis fracture. Neurol Neurochir Pol 2017; 52:334-340. [PMID: 29691052 DOI: 10.1016/j.pjnns.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surgical treatment of odontoid fractures with posterior C1/C2 fusion always leads to severe limitations in mobility of the cervical spine and head. PURPOSE To assess the mobility of the cervical spine in patients treated with various surgical methods after an axis body fracture. MATERIAL AND METHODS A group of 61 subjects receiving surgical treatment in a group of 214 subjects treated for odontoid fractures at one ward of neurosurgery at a regional hospital. Studies also included odontoid peg and Hangman fractures. The range of motion of the head was compared to standards by the International Standard Orthopedic Measurements (ISOM) and to head mobility in a control group of 80 healthy subjects without any pathologies or complaints associated with the cervical spine. Ranges of motion were measured with the CROM goniometre with regard to flexion, extension, right and left lateral flexion and right and left rotation. The functional status was evaluated with Neck Disability Index (NDI) standard questionnaires indicated for patients with cervical spine pain. RESULTS Except for flexion and extension, patients after odontoid fractures had a statistically significantly smaller range of motion of the cervical spine in all planes compared to the control group and ISOM standards. CONCLUSIONS Odontoid fractures lead to limitations in mobility of the cervical spine even after treatment with methods that in theory should preserve the C1/C2 mobility.
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Affiliation(s)
| | - Andrzej Maciejczak
- Medical Faculty of University of Rzeszów, Poland; Department of Neurosurgery, St Luke Hospital, Tarnów, Poland
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A Novel Anterior Odontoid Screw Plate for C1-C3 Internal Fixation: An In Vitro Biomechanical Study. Spine (Phila Pa 1976) 2016; 41:E64-72. [PMID: 26555834 DOI: 10.1097/brs.0000000000001165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical in vitro study was performed using a standardized experimental protocol in a biomechanical spine testing apparatus. OBJECTIVE The aims of this study were to evaluate the biomechanical stability afforded by 4 cervical fixation techniques: anterior cervical plate+odontoid screw+cage (ACP+OS+cage), anterior odontoid screw plate+bone graft (AOSP+bone graft), posterior C2-3 fixation+odontoid screw (C2PS+C3LMS+OS), and posterior C1-3 fixation (C1PS+C2PS+C3LMS). SUMMARY OF BACKGROUND DATA Unstable axis injuries with multiple fracture lines are uncommon injuries, and their management is still challenging for surgeons who aim to achieve primary stability, early mobilization, preserved cervical range of motion (ROM), and favorable outcome. We designed a novel AOSP to assist in this challenging clinical scenario. METHODS Eight fresh-frozen cadaveric spine specimens (C1-C3) were subjected to stepwise destabilization of the C1-3 complex, with serial replication of a type II Hangman fracture, a type II odontoid fracture, and a C2 to C3 disc injury. Intact specimens, destabilized specimens, and destabilized specimens with various stabilization techniques including anterior and posterior techniques, some using our AOSP, were each tested for stability. Each spine was subjected to flexion, and extension testing, left and right lateral bending, and left and right rotation. RESULTS After AOSP+bone graft fixation, the ROMC2-C3 during all loading modes were reduced to values that were significantly less than normal. During all loading modes, AOSP+bone graft fixation significantly outperformed the ACP+OS+cage fixation in limiting ROMC2-C3. During flexion and extension, AOSP+bone graft fixation significantly outperformed the C1PS+C2PS+C3LMS fixation and C2PS+C3LMS+OS fixation in limiting ROMC2-C3. CONCLUSION The AOSP has excellent biomechanical performance when dealing with type I Hangman fractures, type II odontoid fractures, and C2-3 disc injuries. The AOSP+one graft fixation can preserve the function of atlanto-axial joint, which may be a valuable stabilization strategy for these unique injuries.
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Anterior Cervical Discectomy and Fusion Versus Posterior Fixation and Fusion of C2–3 for Unstable Hangman’s Fracture. ACTA ACUST UNITED AC 2015; 28:E61-6. [DOI: 10.1097/bsd.0000000000000150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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C1-C3 Lateral Mass Screw-Rod Fixation and Fusion for C2 Pathologies and Hangman's Fractures. Asian Spine J 2014; 8:735-46. [PMID: 25558315 PMCID: PMC4278978 DOI: 10.4184/asj.2014.8.6.735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/02/2014] [Accepted: 03/03/2014] [Indexed: 01/09/2023] Open
Abstract
Study Design Retrospective clinical study. Purpose We report our experience of eight patients treated with C1-C3 lateral mass rod-screw stabilization and fusion in the treatment of Hangman's fracture and other axis pathologies. Overview of Literature Different surgical approaches, both anterior and posterior, have been described for treating Hangman's fracture and other pathologies where surgery is indicated. Methods All patients who underwent surgical treatment for Hangman's fracture and axial pathology where C1-C3 lateral mass screw-rod stabilization and fusion done, following reduction of the fracture or removal of the pathology were included in this series. The recorded patient management data was retrospectively studied. Results There were 8 cases in total. All were male, with an average age of 40.75 years. Hangman's fracture occurred in 6 cases (75%), one with metastatic squamous cell carcinoma and the remaining with plasmocytoma. Among the Hangman's fractures 4 (66.66%) had no neuro-deficit. Reduction and bilateral C1-C3 lateral mass screw and rod fixation with posterior fusion by bone graft was performed in all cases. In 2 cases, a C2 body tumor was removed transorally. All patients with neuro-deficit fully recovered, except one who expired in the early post-operative period. Rest of all patients were leading a normal life till last follow up. Conclusions Although the number of cases was very small with a relatively short follow up period, C1 and C3 lateral mass screw-rod fixation followed by fusion showed promise as an effective and biomechanically sound way for the treatment of properly selected Hangman's fracture cases, and may also be suitable in other axial pathologies.
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Dalbayrak S, Yaman O, Yılmaz M. A new technique in the surgical treatment of Hangman's fractures: Neurospinal Academy (NSA) technique. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 4:59-63. [PMID: 24744563 PMCID: PMC3980557 DOI: 10.4103/0974-8237.128529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Context: Treatment of Hangman's fractures is still controversial. Hangman's fractures Type II and IIA are usually treated with surgical procedures. Aim: This study aims at describing the Neurospinal Academy (NSA) technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. Settings and Design: NSA technique both pars or pedicle screws are placed bicortically to ensure that anterior surface of C2 vertebral body will be crossed 1-2 mm. A rod is prepared in suitable length and curve to connect the two screws. For placing the rod, sufficient amount of bone is resected from the C2 spinous process. C2 vertebral body is pulled back by means of the screws that crossed the anterior surface of C2 vertebral body. Materials and Methods: Hangman II and IIA patient are treated with NSA technique. Result: Angulated and tilted C2 vertebral body was pulled back and approximated to posterior elements. Conclusions: In Hangman's fractures Type II and IIA with severe vertebral body and pedicle displacement, NSA technique is an effective and reliable treatment alternative for the approximation of posterior elements to the C2 vertebral body, which is tilted, angulated, and dislocated.
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Affiliation(s)
- Sedat Dalbayrak
- Department of Neurosurgery, Neurospinal Academy, Istanbul, Turkey
| | - Onur Yaman
- Clinic of Neurosurgery, Tepecik Education and Training Hospital, Izmir, Turkey
| | - Mesut Yılmaz
- Department of Neurosurgery, Neurospinal Academy, Istanbul, Turkey
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