A Potentially Advantageous Use of a Zero-Profile, Stand-Alone Anterior Interbody Spacer at C2-3 for the Treatment of Hangman’s Fracture: A Technical Case Report

Hangman’s fracture or traumatic spondylolisthesis of the axis is a common fracture pattern in the cervical spine. Nonoperative management with an external orthosis is appropriate in select cases. However, when surgery is necessary, both anterior and posterior approaches can be used, and the optimal approach has not been established. Anterior discectomy and fusion with plating at C2-3 may cause dysphagia from plate prominence, while the posterior fusion of C1-3 eliminates motion of an otherwise healthy atlantoaxial joint, resulting in a significant loss of cervical range of motion. We describe the first published application of a stand-alone, zero-profile implant at the C2-3 segment to treat Hangman’s fracture, a technique already successfully used in the C3-7 region for trauma and degenerative applications. A stand-alone, zero profile interbody spacer was employed in anterior C2-3 arthrodesis surgery for Hangman’s fracture in a 61-year-old female following failure of healing after three months in a hard cervical collar. Late postoperative imaging showed successful fusion and the patient had favorable clinical results with relief of neck pain. A zero-profile, stand-alone implant at C2/3 is an attractive option to surgically treat C2 Hangman’s fracture, potentially minimizing dysphagia attributable to an anterior plate and spare the atlantoaxial joint that is fused with C1-3 posterior arthrodesis. The benefits of the application of this technique may be validated with additional studies.