Clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion_West China Medical Journal

Authors：

DENG Yuxiao ,  LIU Hao

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Hao, Email: liuhao6304@163.com

Keywords：

Hangman fracture; Anterior cervical discectomy and fusion; Clinical outcomes

DOI：

10.7507/1002-0179.201612183

Video：

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Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.

Citation： DENG Yuxiao, LIU Hao. Clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. West China Medical Journal, 2017, 32(11): 1717-1720. doi: 10.7507/1002-0179.201612183 Copy

1.	Schneider RC, Livingston KE, Cave AJ, et al. " Hangman’s fracture” of the cervical spine. J Neurosurg, 1965, 22: 141-154.
2.	Effendi B, Roy D, Cornish B, et al. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg (Br), 1981, 63-B(3): 319-327.
3.	Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am, 1985, 67(2): 217-226.
4.	Liu J, Li Y, Wu Y. One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture. Exp Ther Med, 2013, 5(3): 667-672.
5.	孙厚杰, 蔡小军, 张军, 等. Hangman 骨折的治疗方法选择及疗效分析. 中国脊柱脊髓杂志, 2011, 21(7): 554-560.
6.	王清, 王松, 钟德君, 等. 不稳定性 Hangman 骨折手术入路选择. 中国脊柱脊髓杂志, 2012, 22(6): 526-530.
7.	陈建明, 张成程, 庄颖, 等. 不同后路短节段内固定治疗 Hangman 骨折. 中华创伤杂志, 2013, 29(7): 623-625.
8.	Vender JR, Harrison SJ, McDonnell DE. Fusion and instrumentation at C1-3 via the high anterior cervical approach. Spine, 1999, 24(3): 295-299.
9.	谭明生, 董亮. 对上颈椎损伤治疗原则的探讨. 中国脊柱脊髓杂志, 2013, 23(5): 387-388.
10.	Rajasekaran S, Tubaki VR, Shetty AP. Results of direct repair of type 2 hangman fracture using Iso-C3D navigation: 20 cases. J Spinal Disord Tech, 2012, 25(5): E134-E139.
11.	葛朝元, 郝定均, 贺宝荣, 等. 颈前路钢板内固定治疗不稳定 Hangman 骨折的疗效分析. 中国修复重建外科杂志, 2014, 28(6): 728-732.
12.	蔡贤华, 陈庄洪, 黄继锋, 等. Hangman 骨折损伤病理特点及颈前路钢板内固定治疗. 临床外科杂志, 2007, 15(5): 349-351.
13.	Watanabe M, Nomura T, Toh E, et al. Residual neck pain after traumatic spondylolisthesis of the axis. J Spinal Disord Tech, 2005, 18(2): 148-151.
14.	马毅, 邓树才, 刘建坤, 等. 经常规前路间盘切除植骨融合治疗 Hangman 骨折. 中华医学杂志, 2010, 90(35): 2451-2454.
15.	Muthukumar N. C1-C3 lateral mass fusion for type Ⅱ a and type Ⅲ Hangman’s fracture. J Craniovertebr Junction Spine, 2012, 3(2): 62-66.
16.	Ma W, Xu R, Liu J, et al. Posterior short-segment fixation and fusion in unstable Hangman’s fractures. Spine (Phila Pa 1976), 2011, 36(7): 529-533.
17.	Shin JJ, Kim SJ, Kim TH, et al. Optimal use of the halo-vest orthosis for upper cervical spine injuries. Yonsei Med J, 2010, 51(5): 648-652.
18.	Elmiligui Y, Koptan W, Emran I. Transpedicular screw fixation for type Ⅱ Hangman’s fracture: a motion preserving procedure. Eur Spine J, 2010, 19(8): 1299-1305.
19.	Wu YS, Lin Y, Zhang XL, et al. Management of Hangman’s fracture with percutaneous transpedicular screw fixation. Eur Spine J, 2013, 22(1): 79-86.
20.	Rayes M, Mittal M, Rengachary SS, et al. Hangman’s fracture: a historical and biomechanical perspective. J Neurosurg Spine, 2011, 2: 198-208.
21.	张来仁, 董宏袆, 王世印. 前路或后路手术治疗 Hangman 骨折的影响因素分析及临床疗效观察. 中国矫形外科杂志, 2015, 23(4): 313-317.
22.	李金泉, 徐皓, 姚晓东, 等. 两种不同手术入路治疗不稳定 Hangman 骨折的比较. 中国矫形外科杂志, 2010, 18(4): 280-283.
23.	Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine, 2000, 8: 962-969.

1. Schneider RC, Livingston KE, Cave AJ, et al. " Hangman’s fracture” of the cervical spine. J Neurosurg, 1965, 22: 141-154.
2. Effendi B, Roy D, Cornish B, et al. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg (Br), 1981, 63-B(3): 319-327.
3. Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am, 1985, 67(2): 217-226.
4. Liu J, Li Y, Wu Y. One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture. Exp Ther Med, 2013, 5(3): 667-672.
5. 孙厚杰, 蔡小军, 张军, 等. Hangman 骨折的治疗方法选择及疗效分析. 中国脊柱脊髓杂志, 2011, 21(7): 554-560.
6. 王清, 王松, 钟德君, 等. 不稳定性 Hangman 骨折手术入路选择. 中国脊柱脊髓杂志, 2012, 22(6): 526-530.
7. 陈建明, 张成程, 庄颖, 等. 不同后路短节段内固定治疗 Hangman 骨折. 中华创伤杂志, 2013, 29(7): 623-625.
8. Vender JR, Harrison SJ, McDonnell DE. Fusion and instrumentation at C1-3 via the high anterior cervical approach. Spine, 1999, 24(3): 295-299.
9. 谭明生, 董亮. 对上颈椎损伤治疗原则的探讨. 中国脊柱脊髓杂志, 2013, 23(5): 387-388.
10. Rajasekaran S, Tubaki VR, Shetty AP. Results of direct repair of type 2 hangman fracture using Iso-C3D navigation: 20 cases. J Spinal Disord Tech, 2012, 25(5): E134-E139.
11. 葛朝元, 郝定均, 贺宝荣, 等. 颈前路钢板内固定治疗不稳定 Hangman 骨折的疗效分析. 中国修复重建外科杂志, 2014, 28(6): 728-732.
12. 蔡贤华, 陈庄洪, 黄继锋, 等. Hangman 骨折损伤病理特点及颈前路钢板内固定治疗. 临床外科杂志, 2007, 15(5): 349-351.
13. Watanabe M, Nomura T, Toh E, et al. Residual neck pain after traumatic spondylolisthesis of the axis. J Spinal Disord Tech, 2005, 18(2): 148-151.
14. 马毅, 邓树才, 刘建坤, 等. 经常规前路间盘切除植骨融合治疗 Hangman 骨折. 中华医学杂志, 2010, 90(35): 2451-2454.
15. Muthukumar N. C1-C3 lateral mass fusion for type Ⅱ a and type Ⅲ Hangman’s fracture. J Craniovertebr Junction Spine, 2012, 3(2): 62-66.
16. Ma W, Xu R, Liu J, et al. Posterior short-segment fixation and fusion in unstable Hangman’s fractures. Spine (Phila Pa 1976), 2011, 36(7): 529-533.
17. Shin JJ, Kim SJ, Kim TH, et al. Optimal use of the halo-vest orthosis for upper cervical spine injuries. Yonsei Med J, 2010, 51(5): 648-652.
18. Elmiligui Y, Koptan W, Emran I. Transpedicular screw fixation for type Ⅱ Hangman’s fracture: a motion preserving procedure. Eur Spine J, 2010, 19(8): 1299-1305.
19. Wu YS, Lin Y, Zhang XL, et al. Management of Hangman’s fracture with percutaneous transpedicular screw fixation. Eur Spine J, 2013, 22(1): 79-86.
20. Rayes M, Mittal M, Rengachary SS, et al. Hangman’s fracture: a historical and biomechanical perspective. J Neurosurg Spine, 2011, 2: 198-208.
21. 张来仁, 董宏袆, 王世印. 前路或后路手术治疗 Hangman 骨折的影响因素分析及临床疗效观察. 中国矫形外科杂志, 2015, 23(4): 313-317.
22. 李金泉, 徐皓, 姚晓东, 等. 两种不同手术入路治疗不稳定 Hangman 骨折的比较. 中国矫形外科杂志, 2010, 18(4): 280-283.
23. Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine, 2000, 8: 962-969.

West China Medical Journal

Clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion

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