Abstract
Purpose
The aim of this study was to assess the effectiveness and feasibility of anterior C3 corpectomy and fusion with screw-plate fixation of C2–4 for the treatment of Hangman’s fracture in which spinal cord compression comes from the posterosuperior part of C3 vertebral body and the intervertebral disc injury at the C2–3 level.
Methods
From August 2000 to December 2005, 11 patients (eight males and three females) with traumatic spondylolisthesis of the axis underwent the above surgery. Neurological status was evaluated by the Japanese Orthopaedic Association Score (JOA score). The fusion of the graft, healing of the fracture, and range of motion of the whole cervical spine were examined according to X-ray imaging.
Results
No patient received blood transfusion. There was no deterioration of the neurological function in any case postoperatively. The mean JOA score was significantly improved from 9.1 ± 2.3 preoperatively to 14.8 ± 1.2 at the 12-month postoperative visit. All patients were relieved of axial pain. Imaging evaluation confirmed a high fusion rate and healing rate in all patients. No patient complained of limited mobility of the cervical spine in flexion, extension and rotation. No graft or plate-related complication was observed in any patients during the whole follow-up period. The only postoperative complication was trouble in swallowing liquids in two cases which resolved three months after surgery without any treatment.
Conclusions
Anterior C3 corpectomy and fusion may prove to be safe and applicable for the treatment of complex Hangman’s fractures.
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References
Schneider RC, Livingston KE, Cave A, Hamilton G (1965) Hangman’s fracture of the cervical spine. J Neurosurg 22:141–154
Ebraheim NA, Fow J, Xu R, Yeasting RA (2001) The location of the pedicle and pars interarticularis in the axis. Spine 26:E34–E37
Brashear R Jr, Venters G, Preston ET (1975) Fractures of the neural arch of the axis. A report of 29 cases. J Bone Joint Surg Am 57:879–887
Cornish BL (1968) Traumatic spondylolisthesis of the axis. J Bone Joint Surg 50:31–43
Levine AM, Edwards C (1985) The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 67:217–226
Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 63-B:319–327
Termansen NB (1974) Hangman’s fracture. Acta Orthop 45:529–539
Francis WR, Fielding JW, Hawkins RJ, Pepin J, Hensinger R (1981) Traumatic spondylolisthesis of the axis. J Bone Joint Surg Br 63-B:313–318
Taller S, Suchomel P, Lukáš R, Beran J (2000) CT-guided internal fixation of a hangman’s fracture. Eur Spine J 9:393–397
Cosan TE, Tel E, Arslantas A, Vural M, Guner AI (2001) Indications of Philadelphia collar in the treatment of upper cervical injuries. Eur J Emerg Med 8:33–37
ElMiligui Y, Koptan W, Emran I (2010) Transpedicular screw fixation for type II Hangman’s fracture: a motion preserving procedure. Eur Spine J 19:1299–1305
Xu H, Zhao J, Yuan J, Wang C (2010) Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture. Int Orthop 34:85–88. doi:10.1007/s00264-008-0658-0
Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K (2001) Interobserver and intraobserver reliability of the Japanese Orthopaedic Association Scoring System for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976) 26:1890–1894, discussion 1895
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
Vaccaro AR, Madigan L, Bauerle WB, Blescia A, Cotler JM (2002) Early halo immobilization of displaced traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976) 27:2229–2233. doi:10.1097/01.BRS.0000029247.21652.99
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. doi:10.3171/jns.1996.85.4.0550
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
ElMiligui Y, Koptan W, Emran I (2010) Transpedicular screw fixation for type II Hangman’s fracture: a motion preserving procedure. Eur Spine J 19:1299–1305. doi:10.1007/s00586-010-1401-2
Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine (Phila Pa 1976) 25:1655–1667
Ludwig SC, Kramer DL, Vaccaro AR, Albert TJ (1999) Transpedicle screw fixation of the cervical spine. Clin Orthop Relat Res 359:77–88
Taller S, Suchomel P, Lukas R, Beran J (2000) CT-guided internal fixation of a hangman’s fracture. Eur Spine J 9:393–397
Li XF, Dai LY, Lu H, Chen XD (2006) A systematic review of the management of hangman’s fractures. Eur Spine J 15:257–269. doi:10.1007/s00586-005-0918-2
Wilson AJ, Marshall RW, Ewart M (1999) Transoral fusion with internal fixation in a displaced hangman’s fracture. Spine (Phila Pa 1976) 24:295–298
Rizzolo SJ, Cotler JM (1993) Unstable cervical spine injuries: specific treatment approaches. J Am Acad Orthop Surg 1:57–63
Hegde S (2012) Operative management of spinal injuries. JAPI (supplment) 60:19–24
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Cong Wang and Hui Ma contributed equally to this work.
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Wang, C., Ma, H., Yuan, W. et al. Anterior C3 corpectomy and fusion for complex Hangman’s fractures. International Orthopaedics (SICOT) 37, 89–93 (2013). https://doi.org/10.1007/s00264-012-1703-6
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DOI: https://doi.org/10.1007/s00264-012-1703-6