title: C-2 arteriovenous fistula presenting as a pathologic hangman's fracture: case report.
abstract: The authors report on an 81-year-old woman with a pathologic hangman's fracture secondary to a complex arteriovenous fistula (AVF). The patient presented with severe, unremitting neck pain and was found to have fractures bilaterally through the pars interarticularis of C-2 with significant anterior subluxation of C-2 over C-3 along with widening of the left transverse foramen. Due to an abnormally appearing left vertebral artery (VA) on CT angiography, the patient underwent conventional angiography, which revealed a complex AVF stemming from the left VA at the level of C-2 with dilated posterior cervical veins and a large venous varix. Given the radiographic evidence of bone remodeling and the chronicity of the AVF, it is believed that the C-2 vertebra was weakened over time by the pulsatile and compressive force of the vascular malformation eventually leading to fracture with minimal stress. Coil embolization of the AVF was performed followed by surgical fixation of C-1 to C-4. This case highlights the importance of investigating an underlying disease process in patients who present with significant spinal fractures in the absence of trauma.
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Rajeev D
authors.initials: RD
authors.lastname: Sen
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Carolina Gesteira
authors.initials: CG
authors.lastname: Benjamin
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Donato
authors.initials: D
authors.lastname: Pacione
mesh_terms: D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D016103:Spinal Fractures / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014711:Vertebral Artery / Q000293:injuries
keywords: AVF = arteriovenous fistula; STIR = short T1 inversion recovery; VA = vertebral artery; arteriovenous fistula; axis; cervical spine; hangman's fracture; pathologic; vascular disorders