Evolution In Management Of Hangmans Fracture : From C2 Pedicle Alignment To C2 Pedicle Reformation

Abstract

Objective: Opinions vary regarding the optimal treatment of unstable hangman's fractures. Upper cervical spine surgery is complex and challenging. The advent of intraoperative computed tomography and image guidance has revolutionized its treatment. The aim is to demonstrate anatomical repair of C2 pedicle in hangman fracture and to do pedicle reformation in old and complicated hangmans fracture. Method: This is a prospective observational study. Nine patients operated by single surgeon from 2012 to 2018 were included .In initial seven patients C2 pedicle screw C3 C4 lateral mass screw and rod fixation was done. The last two patients operated were old injuries with no C2 pedicles available for pedicle screw. Results: Patients age ranged from 14 years to 60 years with male female ratio of 8:1. All 5 patients having neurological deficit have improvement in power. Initial 7 patients have good healing of fractured C2 pedicle .The last 2 patients were old fractures with one having severe angulation and displacement and other having spondyloptosis with C2 body placed anterior to C4 body. In both of these patients there was no C2 pedicle as it got absorbed.  In both these patients direct C2 body screw were placed and pedicle reconstruction was done. Both patients improved and are doing well. C1 C2 joint motion was preserved in all. Conclusion: We have first time in the world developed technique of C2 pedicle reformation in 2 old hangmans fracture with reabsorbed pedicles .We have not included C1 in any instrumentation which helped us in preservation of motion at C1 C2 joint.