• Guangzhou Li, Qing Wang, Hao Liu, and Ying Hong.
• Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China; Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China.
• World Neurosurg. 2018 Nov 1; 119: e848-e854.

ObjectiveThe literature on surgical management of atypical hangman's fracture (AHF) is sparse. The aim of this study was to describe an individual surgical strategy using a lag screw-rod technique for treatment of unstable AHF based on different fracture patterns.MethodsA retrospective analysis of 23 patients with unstable AHF was performed. Fractures were classified into 3 patterns: A, 1 fracture line through 1 side of C2 body obliquely and another through pars interarticularis on the other side; B, 1 fracture line through 1 side of C2 body obliquely and another through contralateral lamina; C, bilateral oblique fracture lines through posterior cortex of C2 on different sides. Posterior C2-C3 pedicle screw fixation and fusion using a lag screw-rod technique with different surgical strategies for each fracture pattern was used for all patients. Complications, neck pain, neurologic status, reduction of anterior translation and angulation between C2 and C3, and fusion rate were evaluated.ResultsNo technique-related complications (e.g., spinal cord or nerve injury caused by malposition of screws) occurred. Mean follow-up time was 37 months. Satisfactory reduction and bony union were demonstrated on postoperative radiographs. Neck pain and neurologic deficits caused by C2 injury improved significantly in all patients after operation. No graft or implant-related complications were observed in patients during the entire follow-up period.ConclusionsUsing individual surgical strategies based on different fracture patterns, the posterior C2-C3 lag screw-rod technique may be an effective and reliable option for unstable AHF.Copyright © 2018 Elsevier Inc. All rights reserved.

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