Evolution to Pedicle Reformation Technique In Surgical Management Of Hangman’s Fracture

Abstract: Objective Opinions vary regarding optimal treatment of unstable hangman's fractures. Recent technological advances have allowed short segment, motion preserving fixation, even in complex cases. The aim of the study was to demonstrate C1-C2 motion preserving short segment fusion in hangman’s fracture and the evolution of technique from pedicle realignment to pedicle reformation in complex fractures with resorbed/destroyed C2 pedicles. Methods This was a retrospective study. Patients operated by a single surgeon at a tertiary level centre from 2012 to 2018 were included. The type of fracture, operating time and blood loss was recorded. Neurological deficits were recorded using the ASIA scale with regular clinico-radiological follow up. Results Nine patients (8 male), with a mean age of 36 ± 16.9 years were included. In initial seven patients, C2 pedicle screw, C3 C4 lateral mass screw and rod fixation was done. The last two patients were complex neglected injuries, with one having severe angulation and displacement and the other having spondyloptosis with C2 body placed anterior to C4 body. In both these patients, direct C2 body screw were placed and pedicle reconstruction was done. Mean follow up was 41.4 ± 29.8 months. All 5 patients with pre-operative neurological deficits had improvement in power. C1 C2 joint motion was preserved in all. All patients had bony fusion. Conclusion Preservation of motion at C1 C2 joint should be the goal in all surgically managed hangman’s fracture patients. The technique of C2 pedicle reconstruction can be utilized for the same in old neglected hangman’s fractures.