Abstract
BackgroundSurgical intervention is increasingly performed as the primary treatment of unstable Hangman’s fracture. Some authors have advocated using anterior C2/3 discectomy with interbody fusion and plating to treat unstable Hangman’s fracture combined with intervertebral disc injury; however, there are few reports on unstable Hangman’s fracture treated by anterior interbody fusion with the cervical cage (PEEK material) solely.MethodsThis study was to assess the efficacy of the cervical cage in management of unstable Hangman’s fracture combined with intervertebral disc injury. A cohort of 15 patients with unstable Hangman’s fractures fulfilling the inclusion criteria were prospectively submitted to surgical treatment of anterior C2/3 discectomy and interbody fusion using the cervical cage without plating. According to the Levine and Edwards classification, there were 5 type II, and 10 type IIA cases. The clinical outcome (the visual analog scale and the clinical post-traumatic neck score), radiological findings (angulation, translation, and disc height), and bone healing were assessed at 3, 6, 12, and 24 months.ResultsAll the patients were followed up successfully. There were no intra- or postoperative complications observed. Solid fusion was achieved in all cases by 6 months after surgery. The local kyphotic angle was corrected significantly with the mean preoperative 12.31 ± 2.96 degrees, initial postoperative −1.98 ± 1.62 degrees and the latest follow-up −1.72 ± 1.60 degrees respectively (P < 0.05).The translation was also corrected significantly with the mean preoperative 3.20 ± 1.16 mm, initial postoperative 0.97 ± 0.36 mm, and the latest follow-up 1.05 ± 0.34 mm respectively (P < 0.05). The mean visual analog scale and the clinical post-traumatic neck score improved significantly following surgery (P < 0.05).ConclusionsThis case series demonstrates that anterior C2/3 discectomy and interbody fusion with the cervical cage solely is effective and reliable in management of type II / IIA Hangman’s fracture with C2/3 disc injury when properly indicated.
Highlights
Surgical intervention is increasingly performed as the primary treatment of unstable Hangman’s fracture
Hangman’s fracture, or traumatic spondylolisthesis, which accounts for 4–7 % of all cervical fractures/dislocations [1], is the second most common fracture of the second cervical vertebra [2]
Most authors recommended that surgical intervention should be reserved for cases with failure of conservative measures; pseudoarthrosis, anterior dislocation, angulation of C2 over C3, recurrent axial pain were observed in about 60 % of the cases of type II / II A injuries that were primarily treated with conservative therapy, suggesting the need for an early operation in patients with unstable Hangman’s fractures [3, 6,7,8]
Summary
Surgical intervention is increasingly performed as the primary treatment of unstable Hangman’s fracture. Hangman’s fracture, or traumatic spondylolisthesis, which accounts for 4–7 % of all cervical fractures/dislocations [1], is the second most common fracture of the second cervical vertebra [2]. Most authors recommended that surgical intervention should be reserved for cases with failure of conservative measures; pseudoarthrosis, anterior dislocation, angulation of C2 over C3, recurrent axial pain were observed in about 60 % of the cases of type II / II A injuries that were primarily treated with conservative therapy, suggesting the need for an early operation in patients with unstable Hangman’s fractures [3, 6,7,8]. The authors preferred early surgical treatment of unstable Hangman’s fracture
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