Abstract
Purpose: To compare the effect between C2 spinous muscle complex graft and iliac bone graft in C2-3 pedicle screw fixation for instable Hangman fracture. Using axial spinous muscle complex instead of iliac bone for instable Hangman fracture can decrease neck pain, bone donor site complication, and operation time.Method: The outcomes of C2-3 pedicle screw fixation with C2 spinous muscle complex were compared with iliac bone graft in 18 and 21 patients with instable Hangman fracture. The mean age was 49.1 ± 15.8 years in the complex group and 55.3 ± 12.2 years in the Iliac group, and the mean time to surgery of the patients was 3.3 ± 0.6 days in the complex group and 3.6 ± 0.9 days in the iliac group. Outcome measures including operation time, blood loss, visual analog scale (VAS) for pain, Japanese orthopedic association score (JOA), American spine injure association classification (ASIA), and bone fusion time were collected from medical records. In addition, the postoperative complications were also recorded.Results: There were significant differences in operation time and interoperative blood loss between the two groups (P < 0.01). Also a significant difference was found in VAS score and JOA score between the two groups (P = 0.0012 and P < 0.001, respectively) at 1-month follow-up, whereas, no significant difference was found at other visit time. In the final visit, all patients showed good bone fusion, and two patients shows incision edema and exudation in the iliac group.Conclusion: C2-3 pedicle screw fixation with C2 spinous muscle complex graft maybe a feasible and safe procedure for instable Hangman fracture.
Highlights
Hangman fracture, known as traumatic spondylolisthesis of the axis, was first discovered in 1866 in dead criminals from judicial hanging and was named by Schneider et al in 1965 [1]
Our group reported that 27 patients with atlantoaxial fracture who were treated with C1-2 pedicle screw fixation combined with axial spinous muscle complex had satisfactory recovery [7]
Many studies reported that the preservation of muscle attachments of cervical spine is beneficial in cervical ROM and axial symptom
Summary
Known as traumatic spondylolisthesis of the axis, was first discovered in 1866 in dead criminals from judicial hanging and was named by Schneider et al in 1965 [1]. Sinha and Goyal used the C2 spinous process as a bone graft and waged it using titanium cables for C1-2 posterior fusion in five patients with atlantoaxial dislocation to minimize the donor-site complications and posterior neck pain [6]. Our group reported that 27 patients with atlantoaxial fracture who were treated with C1-2 pedicle screw fixation combined with axial spinous muscle complex had satisfactory recovery [7]. Many studies reported that the preservation of muscle attachments of cervical spine is beneficial in cervical ROM and axial symptom. Riew et al reviewed 11 articles on preserving the C2 muscle attachments and/or C7preserving cervical laminoplasty and reported a similar result that preservation of the posterior cervical muscle has better clinical outcomes [9]. Preservation of the cervical muscles such as the semispinalis cervicis muscle prevents postoperative neck pain and maintains cervical alignment
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