Unstable Hangman's fracture: Anterior or posterior surgery?

CONTEXT: Literature evaluating the efficacy and long-term clinico-radiological outcomes of anterior cervical discectomy and fusion (ACDF) and posterior fixation at C2–C3 for the treatment of unstable hangman's fractures is scanty. AIMS: The aim of this study is to compare the efficacy, clinical...

Descripción completa

Detalles Bibliográficos
Autores principales: Patel, Jwalant Yogesh Kumar, Kundnani, Vishal G, Kuriya, Suraj, Raut, Saijyot, Meena, Mohit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008659/
https://www.ncbi.nlm.nih.gov/pubmed/32089613
http://dx.doi.org/10.4103/jcvjs.JCVJS_112_19
_version_ 1783495510254944256
author Patel, Jwalant Yogesh Kumar
Kundnani, Vishal G
Kuriya, Suraj
Raut, Saijyot
Meena, Mohit
author_facet Patel, Jwalant Yogesh Kumar
Kundnani, Vishal G
Kuriya, Suraj
Raut, Saijyot
Meena, Mohit
author_sort Patel, Jwalant Yogesh Kumar
collection PubMed
description CONTEXT: Literature evaluating the efficacy and long-term clinico-radiological outcomes of anterior cervical discectomy and fusion (ACDF) and posterior fixation at C2–C3 for the treatment of unstable hangman's fractures is scanty. AIMS: The aim of this study is to compare the efficacy, clinical-radiological outcomes, and complications of ACDF and posterior fixation techniques performed for unstable hangman's fractures. SETTINGS AND DESIGN: The study design involves retrospective comparative study. SUBJECTS AND METHODS: This study conducted from 2012 to 2018 included 21 patients with unstable hangman's fracture (Levine and Edwards Type II, IIa and III). All patients were divided into two groups based on the approach taken for fracture fixation (Group A-anterior approach and Group B-posterior approach). Peri-operative clinical, radiological parameters, postoperative complications, and outcomes were evaluated and compared in both the groups. STATISTICAL ANALYSIS USED: Chi-square test and Student's t-test were used. RESULTS: The mean age was 39.8 ± 4.5 years in-group A and 41.3 ± 6.7 years in-group B. The male patients outnumbered the female patients and road traffic accident was the most common cause of unstable fractures. There were statistical significant differences in surgical time (P = 0.15), operative blood loss, pain-free status postsurgery, and hospital stay (P = 0.15) between two groups. No statistically significant differences noted in clinic-radiological outcomes in the form of visual analog scale and fusion rate at final follow-up between two groups at final follow-up. CONCLUSIONS: The unstable hangman's fractures can be effectively managed with both anterior and posterior approaches with comparable clinico-radiological outcome. A minimally invasive nature, earlier pain-free status, early mobilization with reduced hospitalization make the ACDF efficacious, particularly in cases with no medullary canal in C2 pedicles and traumatic C2–3 disc herniation with listhesis compressing the spinal cord.
format Online
Article
Text
id pubmed-7008659
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-70086592020-02-21 Unstable Hangman's fracture: Anterior or posterior surgery? Patel, Jwalant Yogesh Kumar Kundnani, Vishal G Kuriya, Suraj Raut, Saijyot Meena, Mohit J Craniovertebr Junction Spine Original Article CONTEXT: Literature evaluating the efficacy and long-term clinico-radiological outcomes of anterior cervical discectomy and fusion (ACDF) and posterior fixation at C2–C3 for the treatment of unstable hangman's fractures is scanty. AIMS: The aim of this study is to compare the efficacy, clinical-radiological outcomes, and complications of ACDF and posterior fixation techniques performed for unstable hangman's fractures. SETTINGS AND DESIGN: The study design involves retrospective comparative study. SUBJECTS AND METHODS: This study conducted from 2012 to 2018 included 21 patients with unstable hangman's fracture (Levine and Edwards Type II, IIa and III). All patients were divided into two groups based on the approach taken for fracture fixation (Group A-anterior approach and Group B-posterior approach). Peri-operative clinical, radiological parameters, postoperative complications, and outcomes were evaluated and compared in both the groups. STATISTICAL ANALYSIS USED: Chi-square test and Student's t-test were used. RESULTS: The mean age was 39.8 ± 4.5 years in-group A and 41.3 ± 6.7 years in-group B. The male patients outnumbered the female patients and road traffic accident was the most common cause of unstable fractures. There were statistical significant differences in surgical time (P = 0.15), operative blood loss, pain-free status postsurgery, and hospital stay (P = 0.15) between two groups. No statistically significant differences noted in clinic-radiological outcomes in the form of visual analog scale and fusion rate at final follow-up between two groups at final follow-up. CONCLUSIONS: The unstable hangman's fractures can be effectively managed with both anterior and posterior approaches with comparable clinico-radiological outcome. A minimally invasive nature, earlier pain-free status, early mobilization with reduced hospitalization make the ACDF efficacious, particularly in cases with no medullary canal in C2 pedicles and traumatic C2–3 disc herniation with listhesis compressing the spinal cord. Wolters Kluwer - Medknow 2019 2020-01-23 /pmc/articles/PMC7008659/ /pubmed/32089613 http://dx.doi.org/10.4103/jcvjs.JCVJS_112_19 Text en Copyright: © 2020 Journal of Craniovertebral Junction and Spine http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Patel, Jwalant Yogesh Kumar
Kundnani, Vishal G
Kuriya, Suraj
Raut, Saijyot
Meena, Mohit
Unstable Hangman's fracture: Anterior or posterior surgery?
title Unstable Hangman's fracture: Anterior or posterior surgery?
title_full Unstable Hangman's fracture: Anterior or posterior surgery?
title_fullStr Unstable Hangman's fracture: Anterior or posterior surgery?
title_full_unstemmed Unstable Hangman's fracture: Anterior or posterior surgery?
title_short Unstable Hangman's fracture: Anterior or posterior surgery?
title_sort unstable hangman's fracture: anterior or posterior surgery?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008659/
https://www.ncbi.nlm.nih.gov/pubmed/32089613
http://dx.doi.org/10.4103/jcvjs.JCVJS_112_19
work_keys_str_mv AT pateljwalantyogeshkumar unstablehangmansfractureanteriororposteriorsurgery
AT kundnanivishalg unstablehangmansfractureanteriororposteriorsurgery
AT kuriyasuraj unstablehangmansfractureanteriororposteriorsurgery
AT rautsaijyot unstablehangmansfractureanteriororposteriorsurgery
AT meenamohit unstablehangmansfractureanteriororposteriorsurgery