• World Neurosurg · May 2021

    Evolution to Pedicle Reformation Technique In Surgical Management Of Hangman's Fracture.

    • Dattaraj Sawarkar, Mohit Agrawal, SinghPankaj KumarPKDepartment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drpankajsingh11@gmail.com., Shashwat Mishra, Deepak Agrawal, Amandeep Kumar, Satish Verma, Ramesh Doddamani, Rajesh Meena, Kanwaljeet Garg, Hitesh Gurjar, Poodipedi S Chandra, and Shashank S Kale.
    • Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
    • World Neurosurg. 2021 May 1; 149: e481-e490.

    BackgroundOpinions vary regarding optimal treatment of unstable hangman's fractures. Recent technological advances have allowed short segment, motion preserving fixation, even in complex cases. The aim of the study was to demonstrate C1-C2 motion-preserving short-segment fusion in hangman's fracture and the evolution of technique from pedicle realignment to pedicle reformation in complex fractures with resorbed/destroyed C2 pedicles.MethodsThis was a retrospective study. Patients operated by a single surgeon at a tertiary level center from 2012 to 2018 were included. The type of fracture, operating time, and blood loss was recorded. Neurologic deficits were recorded using the American Spinal Injury Association scale with regular clinicoradiologic follow-up.ResultsNine patients (8 male), with a mean age of 36 ± 16.9 years were included. In the initial 7 patients, C2 pedicle screw, C3-C4 lateral mass screw, and rod fixation was done. The last 2 patients were complex neglected injuries, with 1 having severe angulation and displacement and the other having spondyloptosis with C2 body placed anterior to C4 body. In both these patients, direct C2 body screw were placed and pedicle reconstruction was done. Mean follow up was 41.4 ± 29.8 months. All 5 patients with preoperative neurologic deficits had improvement in power. C1-C2 joint motion was preserved in all. All patients had bony fusion.ConclusionsPreservation of motion at the C1-C2 joint should be the goal in all surgically managed hangman's fracture patients. The technique of C2 pedicle reconstruction can be utilized for the same in old neglected hangman's fractures.Copyright © 2021 Elsevier Inc. All rights reserved.

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