Is it feasible to treat unstable hangman's fracture via the primary standard anterior retropharyngeal approach?
OBJECTIVE
The goal of this study was to evaluate the results and feasibility of primary anterior cervical discectomy and fusion (ACDF) with plating for unstable traumatic spondylolisthesis of the axis, the so-called hangman's fracture, via the standard anterior retropharyngeal approach.


METHODS
The clinical and radiological records of 17 patients (14 males and 3 females, mean age: 51 years, range 17-73 years) with unstable hangman's fracture who were treated between January 1996 and June 2012 were reviewed retrospectively. ACDF with plating at C2-3 level was performed in all patients (type II fracture: 12 patients, type IIA fracture: 3 patients and type III fracture: 2 patients, based on the Levine and Edwards classification). Combined morbidity, complications, neurological improvement and fusion rate were assessed.


RESULTS
Seventeen patients underwent fusion surgery via the standard anterior retropharyngeal approach. Four patients required an additional posterior arthrodesis to augment the anterior procedure. Patients wore a Philadelphia collar for 4-6 weeks and fusion at C2-3 was achieved in all patients. Two cases of complications were observed during treatment, comprising of one case of non-union and one case of transient dysphagia that resolved after 3 months. However, none of the patients experienced worsening of the neurological function post-operatively. There were no cases of permanent nerve injury or infection.


CONCLUSIONS
Treatment of the hangman's fracture is dependent on the stability of the injury. Although the treatment for unstable hangman's fracture is still controversial, we carefully suggest that primary ACDF with plating via the standard anterior retropharyngeal approach may be a feasible treatment option. It provides immediate stability and allows for early ambulation while promoting a stable bone union with minimal morbidity.
Department of Neurosurgery, Chonnam National University Medical School and Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju, 501-757, Republic of Korea.
Hyuk
H
Hur
Jung-Kil
JK
Lee
Jae-Won
JW
Jang
Tae-Sun
TS
Kim
Soo-Han
SH
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery*; D017586:Diskectomy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult