Epidural hematoma after immobilization of a "hangman's" fracture: case report and review of the literature.
BACKGROUND
Neurologic deterioration after immobilization of traumatic spondylolisthesis of the axis rarely occurs because of the decompressive nature of the injury itself and the large amount of space available for the cord in the upper cervical spine.


OBJECTIVE
To document neurologic deterioration after reduction (without the use of traction) and halo immobilization of a Type IIA traumatic spondylolisthesis of the axis (hangman's fracture) secondary to an epidural hematoma.


METHODS
Case report. PATIENT SAMPLE AND OUTCOME MEASURES: The patient population consisted of one patient; no outcome measures were used.


METHODS
The medical record and radiographic studies of a 27-year-old patient involved in a motor vehicle crash that resulted in a traumatic spondylolisthesis of the axis were retrospectively reviewed, and a review of the English literature was performed.


RESULTS
Upon evaluation, the patient was found to have, in addition to other injuries, a Type IIA hangman's fracture of the C2 vertebra, which was stabilized in a halo. Shortly thereafter, the patient developed a gradual progressive neurologic deficit. Magnetic resonance imaging revealed the presence of a large epidural hematoma with cord compression treated with posterior laminectomy and transdural decompression of an anterior hematoma. Postoperatively, the patient's neurologic examination improved and returned to normal within 6 months.


CONCLUSIONS
An epidural hematoma can occur after traumatic spondylolisthesis of the axis, but its symptoms may not present until after the spondylolisthesis is treated.
Buchowski
Jacob M
JM
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, Maryland 21287, USA.
Riley
Lee H
LH
D000063:Accidents, Traffic; D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology*; D016267:External Fixators; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D019637:Orthopedic Procedures; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013168:Spondylolisthesis / Q000150:complications* / Q000628:therapy