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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 959-960

Subacute Management of a Dislocated Hangman Fracture, What Happens Afterwards? A Long-Term Follow Up


1 Division of Neurosurgery, The Ohio State University, Columbus, OH, USA; Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
2 Department of Neurosurgery, Ernst von Bergsmann Hospital, Potsdam, Germany
3 Department of Biology, Western University, London, Canada
4 Centro de Investigaciones Biomedica (CIB), University of Cartagena, Cartagena, Colombia
5 Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain

Date of Web Publication26-Aug-2020

Correspondence Address:
Dr. Rafael Martinez-Perez
Department of Neurosurgery, The Ohio State University, 410 W 10th Ave, 43210 Columbus, OH

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.293491

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How to cite this article:
Martinez-Perez R, Joswig H, Rayo N, Moscote-Salazar LR, Gomez PA. Subacute Management of a Dislocated Hangman Fracture, What Happens Afterwards? A Long-Term Follow Up. Neurol India 2020;68:959-60

How to cite this URL:
Martinez-Perez R, Joswig H, Rayo N, Moscote-Salazar LR, Gomez PA. Subacute Management of a Dislocated Hangman Fracture, What Happens Afterwards? A Long-Term Follow Up. Neurol India [serial online] 2020 [cited 2020 Oct 20];68:959-60. Available from: https://www.neurologyindia.com/text.asp?2020/68/4/959/293491




Traumatic spondylolisthesis of the axis (TSA) is defined as a fracture through the pars interarticularis of C2.[1] TSA with anterior luxation of C2-C3 in the absence of neurological deficit is rarely seen.[1] We aim to discuss treatment options for this condition in a subacute setting.

A 39-year-old female presented with neck pain and no neurological deficits following a car accident. CT showed a displaced C2 fracture through the pars interarticularis and she was initially managed with external immobilization [Figure 1]. The patient was then transferred to our center. After an unsuccessful external skull traction, the patient underwent posterior arthrodesis from C0 to C4 with subsequent external immobilization for 5 months [Figure 2]. At 10-year follow-up patient showed complete fusion of C2 and C3 without any signs of instability while remaining neurologically intact [Figure 3].
Figure 1: Plain radiographs (a and b) and a sagittal computed tomography scan (c) showing bilateral fracture through the C2 pars interarticularis with major anterolisthesis (spondyloptosis) on C2. Widening of the upper cervical spinal canal (asterisk *). Sagittal T2 MRI before traction reduction (d) shows a herniated disc at C2-3 with spinal cord signal changes (arrow head) and anterior and posterior longitudinal ligaments disruption (white arrows)

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Figure 2: Pre- (a) and post-traction radiographs (b) showing incomplete reduction of the C2 anterolisthesis. Lateral post-arthrodesis radiographs (c)

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Figure 3: 10-year-follow-up imaging. 3-dimmensional CT (a), sagittal CT (b) and flexion-extension radiographs (c and d) showing complete anterior fusion

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  Discussion Top


Delayed application of traction to this patient after the transfer to a tertiary center might explain the treatment failure. The wide gap between C2 and C3 represented a challenge for instrumented anterior arthrodesis and would also have put the patient to an additional risk of damaging the anterior neck structures.[2] Facing technical limitations due to the significant C2 displacement and a patient's short neck, and after having ruled out anterior compression, a posterior occipito-C4 fusion was favored in the current case. Although this surgical strategy is regarded as less stable than a combined anterior-posterior arthrodesis,[3] continued external immobilization over 10 weeks resulted in good fusion outcome in long term.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 1985;67:217-26.  Back to cited text no. 1
    
2.
Kim J-H, Lee S-K, Hong J-H, Moon BJ, Lee J-K. Retropharyngeal granulation: A delayed complication of anterior cervical discectomy and fusion in C2-3. World Neurosurg 2019;125:87-92.  Back to cited text no. 2
    
3.
Prost S, Barrey C, Blondel B, Fuentes S, Barresi L, Nicot B, et al. Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients. Orthop Traumatol Surg Res 2019;105:703-7.  Back to cited text no. 3
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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