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Is it feasible to treat unstable hangman’s fracture via the primary standard anterior retropharyngeal approach?

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Abstract

Purpose

The goal of this study was to evaluate the results and feasibility of primary anterior cervical discectomy and fusion (ACDF) with plating for unstable traumatic spondylolisthesis of the axis, the so-called hangman’s fracture, via the standard anterior retropharyngeal approach.

Methods

The clinical and radiological records of 17 patients (14 males and 3 females, mean age: 51 years, range 17–73 years) with unstable hangman’s fracture who were treated between January 1996 and June 2012 were reviewed retrospectively. ACDF with plating at C2–3 level was performed in all patients (type II fracture: 12 patients, type IIA fracture: 3 patients and type III fracture: 2 patients, based on the Levine and Edwards classification). Combined morbidity, complications, neurological improvement and fusion rate were assessed.

Results

Seventeen patients underwent fusion surgery via the standard anterior retropharyngeal approach. Four patients required an additional posterior arthrodesis to augment the anterior procedure. Patients wore a Philadelphia collar for 4–6 weeks and fusion at C2–3 was achieved in all patients. Two cases of complications were observed during treatment, comprising of one case of non-union and one case of transient dysphagia that resolved after 3 months. However, none of the patients experienced worsening of the neurological function post-operatively. There were no cases of permanent nerve injury or infection.

Conclusions

Treatment of the hangman’s fracture is dependent on the stability of the injury. Although the treatment for unstable hangman’s fracture is still controversial, we carefully suggest that primary ACDF with plating via the standard anterior retropharyngeal approach may be a feasible treatment option. It provides immediate stability and allows for early ambulation while promoting a stable bone union with minimal morbidity.

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Acknowledgments

This research was financially supported by Chonnam National University, 2011.

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Authors and Affiliations

  1. Department of Neurosurgery, Chonnam National University Medical School and Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju, 501-757, Republic of Korea

    Hyuk Hur, Jung-Kil Lee, Jae-Won Jang, Tae-Sun Kim & Soo-Han Kim

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  1. Hyuk Hur
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  2. Jung-Kil Lee
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  3. Jae-Won Jang
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  4. Tae-Sun Kim
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  5. Soo-Han Kim
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Correspondence to Jung-Kil Lee.

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Hur, H., Lee, JK., Jang, JW. et al. Is it feasible to treat unstable hangman’s fracture via the primary standard anterior retropharyngeal approach?. Eur Spine J 23, 1641–1647 (2014). https://doi.org/10.1007/s00586-014-3311-1

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  • DOI: https://doi.org/10.1007/s00586-014-3311-1

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