Surgical management of axis' traumatic spondylolisthesis (Hangman's fracture).
OBJECTIVE
To evaluate the results of surgical treatment using pedicle screws going through C2 pedicles for fixating the spondylolisthesis of the axis in patients who presented pseudoarthrosis after clinical treatment, or who have no condition for fixation with "halo vest", due to serious head trauma.


METHODS
Ten patients have been operated from June 1998 to April 2002, nine suffering from traumatic spondylolisthesis of the axis caused by car accident and one horse fall. Four of those patients have undergone clinical treatment and presented signs of pseudoarthrosis, suffering intense pain at the movement of the cervical spine. Two of them presented moderate head trauma with multiple fractures of the skull. Another one was submitted to a surgical treatment for an acute extradural hematoma. Three patients presented a serious dislocation of C2 over C3. The patients were submitted to arthrodesis of the fractures with two screws, placed on the C2 pedicles, which allowed a better approximation of the fractures with the alignment of C2-C3. Two other patients required additional fixation with a plate on the lateral masses of C3.


RESULTS
Nine patients had a good post surgery evolution with satisfactory consolidation of the fractures and disappearance of the symptoms. One patient had a good evolution but still has cervical pain resulting from strain.


CONCLUSIONS
The fixation of the traumatic spondylolisthesis of the axis using screws in C2 pedicles and through fractures traces is a good option for treating patients who present pseudoarthrosis after clinical treatment or who present contraindication to the "halo vest", such as skull fracture or great lacerations in the scalp.
Neurosurgery Division, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, University of São Paulo, Ribeirão Preto SP, Brazil. jlromeo@netsite.com.br
José Luiz Romeo
JL
Boullosa
Benedicto Oscar
BO
Colli
Carlos Gilberto
CG
Carlotti
Koji
K
Tanaka
Marcius Benigno Marques
MB
dos Santos
D000328:Adult; D001368:Axis, Cervical Vertebra / Q000293:injuries* / Q000601:surgery; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013168:Spondylolisthesis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome