title: Anterior-only stabilization using cage versus plating with bone autograft for the treatment of type II/IIA Hangman's fracture combined with intervertebral disc injury.
abstract: BACKGROUND
  Anterior C2/3 discectomy and interbody fusion (ACDF) with plating is increasingly performed as the primary treatment of unstable Hangman's fracture; however, plate-related complications, such as screw back-out, plate fracture and soft-tissue injury, is not uncommon. Polyetheretherketone (PEEK) cage has now been developed to provide initial stability before fusion; however, whether and how ACDF with PEEK cage offer better clinical results compared with ACDF with plating in management of Hangman's fracture remains unknown. This study compares the efficacy of ACDF with plating to that of ACDF with PEEK cage in management of type II/IIA Hangman's fractures (according to Levine and Edwards classification) retrospectively.
  
  
  METHODS
  From February 2006 to March 2012, a total of 21 patients with type II/IIA Hangman's fractures combined with intervertebral disc injury underwent ACDF with PEEK cage, and 28 patients underwent ACDF with plating. Perioperative parameters were compared. The average follow-up period was 50.3 months (range 27-76 months). The clinical outcome (visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, and clinical post-traumatic neck score (PTNC)) and radiological outcome (translation of C2, local kyphotic angle (LKA), and fusion status of C2/3) was compared retrospectively.
  
  
  RESULTS
  The operative time and blood loss were significantly less in the ACDF with cage group compared with that in the ACDF with plating group (P < 0.05). All patients showed neurological recovery and achieved solid fusion. There were no significant differences in the clinical and radiological outcomes at final follow-up between groups, except in the LKA and the correction loss rate of LKA which were higher in the ACDF with plating group (P < 0.05). Donor-site pain occurred in two patients (10.1%) within 6 months after operation in the ACDF with plating group and none in the ACDF with cage group. All patients recovered without any adverse effects.
  
  
  CONCLUSIONS
  ACDF with PEEK cage is effective and reliable in management of type II/IIA Hangman's fractures and is more cost-effective due to shorter operative time and less blood loss requirements.
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. suifeng720@163.com.
authors: Fuxin
authors: F
authors: Wei
authors: Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 452529798@qq.com.
authors: Ximin
authors: X
authors: Pan
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. zzy990802@126.com.|The Medical School of Shenzhen University, Shenzhen, China. zzy990802@126.com.
authors: Zhiyu
authors: Z
authors: Zhou
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. cshb1987@163.com.
authors: Shangbin
authors: S
authors: Cui
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. king110@126.com.
authors: Rui
authors: R
authors: Zhong
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. wanglehk@163.com.
authors: Le
authors: L
authors: Wang
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. cshb1987@qq.com.
authors: Manman
authors: M
authors: Gao
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. cnn19900712@126.com.
authors: Ningning
authors: N
authors: Chen
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. 165651513@qq.com.
authors: Zijian
authors: Z
authors: Liang
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. zxnong@hotmail.com.
authors: Xuenong
authors: X
authors: Zou
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. hus163@163.com.
authors: Sheng
authors: S
authors: Huang
authors: Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China. gzsyliu@tom.com.
authors: Shaoyu
authors: S
authors: Liu
mesh_terms: D000328:Adult; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000293:injuries*; D001577:Benzophenones; D016025:Bone Transplantation; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D007403:Intervertebral Disc / Q000293:injuries; D007659:Ketones; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011108:Polymers; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D054854:Vertebroplasty
chemical_list: D001577:Benzophenones; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols