title: Cervical cage without plating in management of type II / II A Hangman's fracture combined with intervertebral disc injury.
abstract: BACKGROUND
  Surgical intervention is increasingly performed as the primary treatment of unstable Hangman's fracture. Some authors have advocated using anterior C2/3 discectomy with interbody fusion and plating to treat unstable Hangman's fracture combined with intervertebral disc injury; however, there are few reports on unstable Hangman's fracture treated by anterior interbody fusion with the cervical cage (PEEK material) solely.
  
  
  METHODS
  This study was to assess the efficacy of the cervical cage in management of unstable Hangman's fracture combined with intervertebral disc injury. A cohort of 15 patients with unstable Hangman's fractures fulfilling the inclusion criteria were prospectively submitted to surgical treatment of anterior C2/3 discectomy and interbody fusion using the cervical cage without plating. According to the Levine and Edwards classification, there were 5 type II, and 10 type IIA cases. The clinical outcome (the visual analog scale and the clinical post-traumatic neck score), radiological findings (angulation, translation, and disc height), and bone healing were assessed at 3, 6, 12, and 24 months.
  
  
  RESULTS
  All the patients were followed up successfully. There were no intra- or postoperative complications observed. Solid fusion was achieved in all cases by 6 months after surgery. The local kyphotic angle was corrected significantly with the mean preoperative 12.31 ± 2.96 degrees, initial postoperative -1.98 ± 1.62 degrees and the latest follow-up -1.72 ± 1.60 degrees respectively (P < 0.05).The translation was also corrected significantly with the mean preoperative 3.20 ± 1.16 mm, initial postoperative 0.97 ± 0.36 mm, and the latest follow-up 1.05 ± 0.34 mm respectively (P < 0.05). The mean visual analog scale and the clinical post-traumatic neck score improved significantly following surgery (P < 0.05).
  
  
  CONCLUSIONS
  This case series demonstrates that anterior C2/3 discectomy and interbody fusion with the cervical cage solely is effective and reliable in management of type II / IIA Hangman's fracture with C2/3 disc injury when properly indicated.
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. suifeng720@163.com.
authors.forename: Fuxin
authors.initials: F
authors.lastname: Wei
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. wanglehk@163.com.
authors.forename: Le
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. zzy990802@126.com.|The medical school of Shenzhen University, Shenzhen, Guangdong, China. zzy990802@126.com.
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. king110@126.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhong
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. gzsyliu@tom.com.
authors.forename: Shaoyu
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. cshb1987@163.com.
authors.forename: Shangbin
authors.initials: S
authors.lastname: Cui
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 452529798@qq.com.
authors.forename: Ximin
authors.initials: X
authors.lastname: Pan
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. gaomanm@mail2.sysu.edu.cn.
authors.forename: Manman
authors.initials: M
authors.lastname: Gao
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D007403:Intervertebral Disc / Q000293:injuries; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography