• Song Wang, Qing Wang, Han Yang, Jianping Kang, Gaoju Wang, and Yueming Song.
• Department of Orthopedics, West China Hospital, Sichuan University, NO. 37 Guoxue St. of Wuhou District, Chengdu, 610041, Sichuan, China.
• Eur Spine J. 2017 Apr 1; 26 (4): 1284-1290.

PurposeThe goal of the study was to describe the lag screw-rod (LSR) technique for the treatment of unstable Hangman's fracture as an attempt to pull C2 vertebral body back to posterior elements easily and immobilize C2 relative to C3 simultaneously.MethodsTwenty-one patients with unstable Hangman's fracture were treated with the LSR technique from January 2008 to October 2014. The clinical and radiological records were reviewed retrospectively. The angulation and displacement of C2 on C3 were evaluated. Complications, neck pain, neurological improvement, and fusion rate were assessed.ResultsThe LSR technique was used for C2-C3 pedicle fixation and fusion in all the patients. The C2 vertebral body was pulled back to posterior elements successfully. The angulation and displacement of C2 on C3 were rectified obviously. No intra-operative or post-operative spinal cord or vertebral injury was observed. Visual analogue scale (VAS) scores for neck pain decreased gradually after operation. The patients with spinal cord injury were recovered at final following up. All patients achieved bony fusion without internal fixation failures.ConclusionsThe LSR technique is an effective and reliable treatment for unstable Hangman's fractures. The technique has the advantages of pulling back the C2 vertebral body back to posterior elements easily and immobilizing C2 relative to C3 simultaneously.

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