Anterior cervical discectomy and fusion plus plating for unstable Hangman's fractures

Abstract

Objective To investigate the clinical effectiveness of anterior cervical discectomy and fusion (ACDF)plus plating in the treatment of unstable Hangman's fractures. Methods A retrospective case series study was carried out to analyze 12 patients who received ACDF plus plate internal fixation for unstable Hangman's fracture admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from July 2014 to July 2018. There were nine males and three females, aged 24-70 years with an average of 46.2 years. According to Levine-Edwards typing, there were seven patients of type Ⅱ, four patients of type Ⅱ A and one patient of type Ⅲ. There were two patients of grade D and 10 patients of grade E according to the American Spinal Injury Association (ASIA) classification. The operation time, intraoperative blood loss and the operational complications were recorded. At 3 days, 1, 3, 6, 12 and 24 months after operation, the height of intervertebral disc, physiological curvature of cervical spine, fracture healing and bone graft fusion were evaluated. The recovery of neurological function was assessed by ASIA, and the neck pain relief and function improvement was assessed by visual analogue scale (VAS) and the neck disability index (NDI). Results All patients were followed for 6-48 months(mean, 27.7 months). The operation time ranged from 50-100 minutes, with an average of 72.5 minutes. The intraoperative blood loss was 30-120 ml (mean, 65.8 ml). No serious complications occurred during and after operation. Two patients had dysphagia after operation, and the symptoms were relieved at the follow-up of 3 months. All patients achieved bony fusion of C2-3 within the 6 month follow-up. No subsidence or migration of cages and significant loss of intervertebral space height were observed. The patient's neck and occipital pain was relieved obviously, and the flexion, extension and rotation of cervical spine were good. The neurologic dysfunction of two patients of ASIA Grade D recovered after surgery, and the final ASIA grade was E. The VAS score was decreased from 5.0 (4.0, 6.0)points preoperatively to 1.0(0, 1.0)points at the last follow-up (P<0.01). The NDI score was improved from (28.5±6.4)points preoperatively to (5.3±2.7)points at the last follow-up (P<0.01). Conclusion ACDF combined with plate internal fixation can provide immediate postoperative stability, high fusion rate, less complications, less pain, and satisfactory function recovery. Key words: Axis; Decompression, surgical; Fracture fixation, internal; Hangman's fracture