Abstract

Introduction: Traumatic spondylolisthesis of C2 (Axis) which is also known as hangman fracture was initially noted in 1965 by Schneider et al. There are two kinds of it, i.e. (i) one of a hyperextensive-distractive mechanism with the very severe neurological lesion leading to the classical injury due to hanging and (ii) one of a hyperextensive-compressive mechanism without neurological lesion of current traffic injuries or with slight neurological symptoms. The latter more often occurring type of injury encompasses a relatively wide range. The optimal therapy for traumatic fractures of the neural arch of the axis is still controversial. Indications for surgery depend on the type of hangman’s fracture and/or additional injuries of the intervertebral disc or ligaments. Here we shall share our experience of surgical management of hangman’s fracture with review of literature.

Method: 29 patients with hangman’s fracture were treated between 2004 and 2015. All patients presented with neck pain and 7 with neurological deficit.3 patients with stable fracture were treated by rigid collar. Of the 17 surgically treated patients 16 were managed with screws, placed on the C2 pedicles. Of them 7 required additional fixation with rod & screw on the lateral masses of C3 and another with C4 pedicle screw as he had associated C3 body fracture. 1 patient underwent anterior discectomy and fusion with internal fixation.

Results: All the patients had good post surgical outcome with satisfactory fusion of the fractures.

Conclusions: Surgery provides plausible results. Compared to conservative treatment, it can offer significant benefits: 1) immediate, better and stable reposition; 2) high fusion rate; 3) shortening of the treatment period with better quality of life. Though technically difficult, transpedicular screw fixation is the best option as it preserves the motion more than other techniques.

Keywords: Traumatic spondylolisthesis, hyperextensive, hangman’s fracture.