EFFECTIVENESS OF ANTERIOR CERVICAL PLATE FIXATION FOR UNSTABLE Hangman FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GEChaoyuan ,  HAODingjun , HEBaorong , LIUTuanjiang , WANGXiaodong , WUQining

Department of Spinal Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P. R. China;

Corresponding author：

HAODingjun, Email: haodingjun@126.com

Keywords：

Hangman fracture; Traumatic spondylolisthesis of the axis; Anterior cervical approach; Plate internal fixation

DOI：

10.7507/1002-1892.20140162

Video：

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Objective To explore the effectiveness of anterior cervical plate internal fixation in the treatment of unstable Hangman fracture. Methods Between May 2006 and May 2010, 42 patients with unstable Hangman fracture were treated by anterior cervical plate internal fixation. There were 30 males and 12 females with an average age of 36.5 years (range, 22-64 years). According to the Levine-Edwards classification, 25 cases were rated as type Ⅱ, 15 cases as type Ⅱ A, and 2 cases as type Ⅲ. Eight patients had spinal cord injury. The average interval between injury and operation was 5 days (range, 3-14 days). The X-ray, CT, and MRI were done pre-and post-operatively to evaluate the cervical physiological curvature, the intervertebral disc height of C_2,3, the fracture-healing, and bone fusion. The effectiveness was evaluated using visual analogue scale (VAS) for occipito-cervical pain, Neck Disability Index (NDI) for cervical spine function, and the Japanese Orthopaedic Association (JOA) score for neurological functional recovery. Results All incisions healed by first intention. No neurological deterioration or internal fixation failure was observed. All of the patients were followed up 2-5 years (mean, 3.5 years). The complications were dysdipsia in 3 cases and dysphagia in 4 cases, which alleviated spontaneously after 1 week. All the patients were almost free from occipito-cervical pain and the limited cervical spine motion. Neurological function was improved in 8 cases of spinal cord injury, and complete decompression was observed in 6 cases who had spinal cord compression. The bone fusion was observed at 6.5 months on average (range, 6-8 months); the mean fracture-healing time was 10.5 months (range, 9-12 months). The VAS, NDI, and JOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores (P<0.05), significant improvement scores were achieved at last follow-up when compared with the scores at 3 months (P<0.05). The intervertebral disc height of C_2,3, the reconstructed curvature and stability of the cervical spine, and the spine movement were good. Conclusion The method of anterior cervical plate internal fixation can achieve satisfactory reduction and fusion, less complications, negligible impact on the cervical movement. So it is an ideal method to treat unstable Hangman fracture.

Citation： GEChaoyuan, HAODingjun, HEBaorong, LIUTuanjiang, WANGXiaodong, WUQining. EFFECTIVENESS OF ANTERIOR CERVICAL PLATE FIXATION FOR UNSTABLE Hangman FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(6): 728-732. doi: 10.7507/1002-1892.20140162 Copy

1.	Schneider RC, Livingston KE, Cave AJ, et al. "Hangman's fracture" of the cervical spine. J Neurosurg, 1965, 22:141-154.
2.	Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg (Am), 1985, 67(2):217-226.
3.	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.
4.	Liu J, Li Y, Wu Y. One-stage posterior C₂ and C₃ pedicle screw fixation or combined anterior C₁-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.	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.
9.	王吉兴, 金大地, 姚军, 等. Halo-vest在重建上颈椎稳定性中的应用. 中国修复重建外科杂志, 2004, 18(5):399-401.
10.	Longo UG, Denaro L, Campi S, et al. Upper cervical spine injuries:indications and limits of the conservative management in Halo vest. A systematic review of efficacy and safety. Injury, 2010, 41(11):1127-1135.
11.	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.
12.	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.
13.	Muthukumar N. C₁-C₃ lateral mass fusion for type Ⅱa and type ⅡI Hangman's fracture. J Craniovertebr Junction Spine, 2012, 3(2):62-66.
14.	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.
15.	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.
16.	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.
17.	Ludwig SC, Kramer DL, Balderston RA, et al. Placement of pedicle screws in the human cadaveric cervical spine:comparative accuracy of three techniques. Spine (Phila Pa 1976), 2000, 25(13):1655-1667.
18.	Xu H, Zhao J, Yuan J, et al. Anterior discectomy and fusion with internal fixation for unstable hangman's fracture. Int Orthop, 2010, 34(1):85-88.
19.	Ying Z, Wen Y, Xinwei W, et al. Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976), 2008, 33(3):255-258.
20.	Chittiboina P, Wylen E, Ogden A, et al. Traumatic spondylolisthesis of the axis:a biomechanical comparison of clinically relevant anterior and posterior fusion techniques. J Neurosurg Spine, 2009, 11(4):379-387.
21.	张沛, 刘斌, 吴一民, 等. 不稳定 Hangman 骨折颈椎前后路融合金属植入物内固定方式的对比. 中国组织工程研究与临床康复, 2011, 15(39):7295-7298.
22.	尹毅, 李柳炳, 张鹏, 等. Hangman 骨折手术治疗方法的选择. 中国骨与关节损伤杂志, 2011, 26(9):803-804.
23.	Lied B, Roenning PA, Sundseth J, et al. Anterior cervical discectomy with fusion in patients with cervical disc degeneration:a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg, 2010, 10:10.
24.	Arts MP, Brand R, van den Akker E, et al. The NEtherlands Cervical Kinematics (NECK) trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation. BMC Musculoskelet Disord, 2012, 11:122.
25.	Bhadra Ak, Raman AS, Casey AT, et al. Single-level cervical radiculopathy:clinical outcome and cost-effectiveness of four techniques of anterior cervical discectomy and fusion and disc arthroplasty. Eur Spine J, 2009, 18(2):232-237.

1. Schneider RC, Livingston KE, Cave AJ, et al. "Hangman's fracture" of the cervical spine. J Neurosurg, 1965, 22:141-154.
2. Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg (Am), 1985, 67(2):217-226.
3. 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.
4. Liu J, Li Y, Wu Y. One-stage posterior C₂ and C₃ pedicle screw fixation or combined anterior C₁-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. 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.
9. 王吉兴, 金大地, 姚军, 等. Halo-vest在重建上颈椎稳定性中的应用. 中国修复重建外科杂志, 2004, 18(5):399-401.
10. Longo UG, Denaro L, Campi S, et al. Upper cervical spine injuries:indications and limits of the conservative management in Halo vest. A systematic review of efficacy and safety. Injury, 2010, 41(11):1127-1135.
11. 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.
12. 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.
13. Muthukumar N. C₁-C₃ lateral mass fusion for type Ⅱa and type ⅡI Hangman's fracture. J Craniovertebr Junction Spine, 2012, 3(2):62-66.
14. 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.
15. 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.
16. 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.
17. Ludwig SC, Kramer DL, Balderston RA, et al. Placement of pedicle screws in the human cadaveric cervical spine:comparative accuracy of three techniques. Spine (Phila Pa 1976), 2000, 25(13):1655-1667.
18. Xu H, Zhao J, Yuan J, et al. Anterior discectomy and fusion with internal fixation for unstable hangman's fracture. Int Orthop, 2010, 34(1):85-88.
19. Ying Z, Wen Y, Xinwei W, et al. Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976), 2008, 33(3):255-258.
20. Chittiboina P, Wylen E, Ogden A, et al. Traumatic spondylolisthesis of the axis:a biomechanical comparison of clinically relevant anterior and posterior fusion techniques. J Neurosurg Spine, 2009, 11(4):379-387.
21. 张沛, 刘斌, 吴一民, 等. 不稳定 Hangman 骨折颈椎前后路融合金属植入物内固定方式的对比. 中国组织工程研究与临床康复, 2011, 15(39):7295-7298.
22. 尹毅, 李柳炳, 张鹏, 等. Hangman 骨折手术治疗方法的选择. 中国骨与关节损伤杂志, 2011, 26(9):803-804.
23. Lied B, Roenning PA, Sundseth J, et al. Anterior cervical discectomy with fusion in patients with cervical disc degeneration:a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg, 2010, 10:10.
24. Arts MP, Brand R, van den Akker E, et al. The NEtherlands Cervical Kinematics (NECK) trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation. BMC Musculoskelet Disord, 2012, 11:122.
25. Bhadra Ak, Raman AS, Casey AT, et al. Single-level cervical radiculopathy:clinical outcome and cost-effectiveness of four techniques of anterior cervical discectomy and fusion and disc arthroplasty. Eur Spine J, 2009, 18(2):232-237.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ANTERIOR CERVICAL PLATE FIXATION FOR UNSTABLE Hangman FRACTURE

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