Posterior fixation and fusion of unstable Hangman’s fracture by using intraoperative three-dimensional fluoroscopy-based navigation

Abstract

The purpose of this study was to assess the efficacy and accuracy of posterior screw fixation for unstable Hangman's fracture using intraoperative 3D fluoroscopy-based navigation. 14 patients with unstable Hangman's fractures (11 males and 3 females), ranging in age from 21 to 59 years, received posterior fixation assisted by an intraoperative 3D fluoroscopy-based navigation system: 11 Levine-Edwards type II and three type IIA cases. The American Spine Injury Association grade was D in 2 and E in 12 cases. Operation time was 110 min (range 90-140 min). Hospital stay was 7.6 days (range 5-12 days). All the patients were observed for an average of 28.8 months (range 15-50 months). No screw-related injury to nerve, or vertebral artery was observed intraoperatively. An average of four screws/patient were inserted. Pedicle screws were placed into C2 and C3, and 5 screws were into the lateral mass of C3. Screw placement accuracy was evaluated using postoperative CT, according to the modified classification of Gertzbein and Robbins; one screw was grade 2 in C2, and three screws were grade 2 in the pedicle of C3. No grade 3 misplacement or clinical deficits were noted. C3 lateral mass screws were successfully inserted. Neck pain was relieved in each case. Neurologic status improved from D to E in 2 cases. Solid fusion was demonstrated in all the cases by static and dynamic films during the final follow-up. This case series demonstrates that intraoperative 3D fluoroscopy-based navigation is a safe, accurate, and effective tool for screw placement in patients with unstable Hangman's fracture.