title: Intraoperative angiography to prevent vertebral artery injury during reduction of a dislocated hangman fracture. Case report.
abstract: The authors report on a 38-year-old woman with a dislocated hangman fracture associated with unilateral vertebral artery (VA) occlusion. The patient presented with a mild central cord syndrome, as well as anterior subluxation of the C-2 vertebral body upon C-3, bilateral neural arch fractures, and a unilateral locked facet joint. Digital subtraction angiography revealed occlusion of the right VA, with the posterior cerebral circulation entirely dependent on the left VA. Intraoperative angiography demonstrated that complete reduction of the dislocation would have caused severe stenosis of the left VA; partial reduction and anterior fixation were performed instead, with excellent neurological outcome. In this case, intraoperative angiography was particularly useful for preventing brain-related ischemic complications during reduction.
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan. toshi@nsg.med.tohoku.ac.jp
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ezura
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Sato
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshimoto
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001368:Axis, Cervical Vertebra / Q000293:injuries*; D020214:Cerebrovascular Trauma / Q000517:prevention & control*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D004204:Joint Dislocations / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D014711:Vertebral Artery / Q000000981:diagnostic imaging* / Q000293:injuries*