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Transpedicular screw fixation for type II Hangman’s fracture: a motion preserving procedure

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Abstract

Opinions have varied regarding the optimal treatment of an unstable Hangman’s fracture. C2 pedicle screw instrumentation is a biomechanically strong fixation which although done through a simple posterior approach, is a technically demanding procedure. This prospective, non-randomized multicentre study included 15 consecutive patients with displaced type II traumatic spondylolisthesis of the axis. There were nine males and six females with a mean age of 37 years at surgery. The cause of injury was a road traffic accident in 11 patients and a fall from height in 4 patients. All patients had a single stage reduction and direct transpedicular screw fixation through the C2 pedicles. During follow-up, clinical evaluation and plain X-rays were performed at each visit; at 6-month follow-up, additional dynamic lateral flexion/extension views and a CT scan were performed. The average follow-up period was 32 months (range 25–56 months). At final follow-up, all patients were asymptomatic and regained a good functional outcome with no limitation of range of motion; all the patients showed solid union with no implant failure. There were no neurological complications. At 6-month follow-up, CT evaluation showed fusion in all patients and an adequate position of 28 screws. Two pedicle screws (6.6%) showed minimal (defined as <2 mm) intrusion; one into the spinal canal and the other into the vertebral foreamen. Transpedicular screw fixation through the C2 pedicles is a safe and effective method in treating type II traumatic spondylolisthesis of the axis resulting in good clinical and radiological outcomes. Adequate reduction was achieved and motion segments were preserved with its use.

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References

  1. Roda JM, Castro A, Blazquez MG (1984) Hangman’s fracture with complete dislocation of C-2 on C-3. J Neurosurg 60:633–635

    Article  CAS  PubMed  Google Scholar 

  2. Hadley MN, Browner C, Sonntag VKH (1985) Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 17:281–290

    Article  CAS  PubMed  Google Scholar 

  3. Schneider RC, Livingston KE, Cave AJE, Gilbert H (1965) Hangman’s fracture of the cervical spine. J Neurosurg 22:141–154

    Article  CAS  PubMed  Google Scholar 

  4. Grogono BJS (1954) Injuries of the atlas and axis. J Bone Joint Surg 36-B(3):397–410

    Google Scholar 

  5. Delorme TL (1967) Axis pedicle fractures. J Bone Joint Surg 49-A:1471

    Google Scholar 

  6. Brashear HR Jr, Venters GC, Preston ET (1975) Fractures of the neural arch of the axis. A report of twenty-nine cases. J Bone Joint Surg 57-A:879–887

    Google Scholar 

  7. Francis WR, Fielding JW, Hawkins RJ, Pepin J, Hensinger R (1981) Traumatic spondylolisthesis of the axis. J Bone Joint Surg 63-B(3):313–318

    CAS  Google Scholar 

  8. Termansen NB (1974) Hangman’s Fracture. Acta Orthop Scandinavica 45:529–539

    Article  CAS  Google Scholar 

  9. Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fracture of the ring of the axis: a classification based on the analysis of 131 cases. J Bone Joint Surg 63-B(3):319–327

    CAS  Google Scholar 

  10. Levine AM, Edwards CC (1985) The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg 67-A:217–226

    Google Scholar 

  11. Cornish BL (1968) Traumatic spondylolisthesis of the axis. J Bone Joint Surg 50-B(2):31–43

    Google Scholar 

  12. Leconte P (1964) Fracture et luxation des deux premières vertèbres cervicales. In: Judet R (ed) Luxation Congenénitale de la Hanche: Fractures du Cou-de-pied Rachis Cervical. Actualités de Chirurgie Orthopédique de l’Hö pital Raymond-Poincaré, vol 3. Masson et Cie, Paris, pp 147–166

    Google Scholar 

  13. Judet R, Roy-Camille R, Saillant G (1970) Actuallites de chiirugie orthopedique de l’hopital Raymound-pointcarre: fracture du rachis cervical, vol 8. Masson, Paris, pp 174–195

    Google Scholar 

  14. Vaccaro AR, Madigan L, Bauerle WB, Blescia A, Cotler JM (2002) Early halo immobilization of displaced traumatic spondylolisthesis of the axis. Spine 27(20):2229–2233

    Article  PubMed  Google Scholar 

  15. Coric D, Wilson JA, Kelly DL Jr (1996) Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg 85:550–554

    Article  CAS  PubMed  Google Scholar 

  16. Alan ML, Alan D (2005) Traumatic spondylolisthesis of the axis: hangman’s fracture. In: Clark CR (ed) The cervical spine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 629–649

    Google Scholar 

  17. Zavanone M, Guerra P, Rampini P, Crotti F, Vaccari U (1991) Traumatic fractures of the craniovertebral junction. Management of 23 cases. J Neurosurg Sci 35:17–22

    CAS  PubMed  Google Scholar 

  18. Tuite GF, Papadopoulos SM, Sonntag VK (1992) Caspar plate fixation for the treatment of complex hangman’s fractures. Neurosurgery 30(5):761–764 (discussion 764–765)

    Article  CAS  PubMed  Google Scholar 

  19. Ying Z, Wen Y, Xinwei W, Yong T, Hongyu L, Zhu H, Qinggang Z, Weihong Z, Yonggeng C (2008) Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis. Spine 33(3):255–258

    Article  PubMed  Google Scholar 

  20. Borne GM, Bedou GL, Pinaudeau M (1984) Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg 60:88–93

    Article  CAS  PubMed  Google Scholar 

  21. Muller EJ, Wick M, Muhr G (2000) Traumatic spondylolisthesis of the axis: treatment rationale based on the stability of the different fracture types. Eur Spine J 9:123–128

    Article  CAS  PubMed  Google Scholar 

  22. Verheggen R, Jansen J (1998) Hangman’s fracture: arguments in favor of surgical therapy for type II and III according to Edwards and Levine. Surg Neurol 49(3):253–261 (discussion 261–262)

    Article  CAS  PubMed  Google Scholar 

  23. Boullosa JL, Colli BO, Carlotti CG Jr, Tanaka K, dos Santos MB (2004) Surgical management of axis’ traumatic spondylolisthesis (Hangman’s fracture). Arq Neuropsiquiatr 62(3B):821–826

    PubMed  Google Scholar 

  24. Hakało J, Wroński J (2008) Operative treatment of hangman’s fractures of C2. Posterior direct pars screw repair or anterior plate-cage stabilization? Neurol Neurochir Pol 42(1):28–36

    PubMed  Google Scholar 

  25. Ludwig SC, Kramer DL, Vaccaro AR, Albert TJ (1999) Transpedicle screw fixation of the cervical spine. Clin Orthop Relat Res 359:77–88

    Article  PubMed  Google Scholar 

  26. Ludwig SC, Kowalski JM, Edwards CC II, Heller JG (2000) Cervical pedicle screws: comparative accuracy of two insertion technique. Spine 25:2675–2681

    Article  CAS  PubMed  Google Scholar 

  27. Taller S, Suchomel P, Lukas R, Beran J (2000) CT-guided internal fixation of a hangman’s fracture. Eur Spine J 9(5):393–397

    Article  CAS  PubMed  Google Scholar 

  28. Rajasekaran S, Vidyadhara S, Shetty AP (2007) Iso-C3D fluoroscopy-based navigation in direct pedicle screw fixation of Hangman fracture: a case report. J Spinal Disord Tech 20(8):616–619

    Article  CAS  PubMed  Google Scholar 

  29. Roy-Camille R, Saillant G, Mazel C (1989) Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plats and screws. In: The Cervical Spine Research Society (ed) The cervical spine, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 390–403

    Google Scholar 

  30. Abumi K, Kaneda K (1997) Pedicle screw fixation for non traumatic lesions of the cervical spine. Spine 22:1853–1863

    Article  CAS  PubMed  Google Scholar 

  31. Samaha C, Lazennec JY, Laporte C, Saillant G (2000) Hangman's fracture: the relationship between asymmetry and instability. J Bone Joint Surg 82(7):1046–1052

    Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Department, Faculty of Medicine, Cairo University, Giza, Egypt

    Yasser ElMiligui, Wael Koptan & Ihab Emran

  2. 60 Gezzirat El Arab Street, Mohandeseen, Giza, 12411, Egypt

    Wael Koptan

  3. 139 Tahrir Street, Dokki, Giza, 12411, Egypt

    Yasser ElMiligui

  4. 3 Adan Street, Mohandeseen, Giza, 12411, Egypt

    Ihab Emran

Authors
  1. Yasser ElMiligui
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  2. Wael Koptan
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  3. Ihab Emran
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Correspondence to Wael Koptan.

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ElMiligui, Y., Koptan, W. & Emran, I. Transpedicular screw fixation for type II Hangman’s fracture: a motion preserving procedure. Eur Spine J 19, 1299–1305 (2010). https://doi.org/10.1007/s00586-010-1401-2

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  • DOI: https://doi.org/10.1007/s00586-010-1401-2

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