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Abstract
Objectives
To evaluate the surgical indications and to compare the results of the anterior plate fixation and transpedicular fixation in cases of traumatic spondylolisthesis of the axis.
Materials and Methods
From 1987 to 2001, eighteen of 26 cases of traumatic spondylolisthesis of the axis were treated by anterior plate fixation and 8 of 26 by transpedicular screw fixation. Two of 8 cases received unilateral screw fixation and 6 bilateral fixation. Two cases of the transpedicular screw fixation group were treated by additional posterior plate fixation. Operative indication was an unstable fracture, namely, with over 3.5 mm of anterior displacement, over 10° of angulation, i.e., Levine types II, IIA, III, and IA. Postoperatively, Philadelphia orthosis or a soft collar was applied for 6 to 8 weeks.
Results
All cases achieved bone union. One case of neck pain, three cases of neck motion limitation and three cases of a kyphotic deformity exceeding 10° were observed in the posterior transpedicular screw fixation group. In terms of surgical complications, two cases of transient dysphagia were observed in the anterior plate fixation group and two cases of screw malposition in the transpedicular screw fixation group. The transpedicular screw fixation technique has some associated problems, such as a large operative wound scar, a large bleeding volume, and technical difficulty.
Conclusion
Both the anterior plate fixation and transpedicular screw fixation methods are useful treatment methods for Levine type II, IIA and III hangman fracture for early bone union and early rehabilitation. The anterior plate fixation technique is easi-er and has fewer complications than posterior transpedicular screw fixation, therefore, the transpedicular screw fixation method should be confined to the management of type IA fracture with rotational displacement.
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Fig. 1-A.
21-year-old woman sustained type II-A hangman’s fracture, secondary to traffic accident. Fig. 2-B. After anterior plate fixation, 3 months of follow-up lateral radiograph showed solid fusion.
Fig. 2-A.
22-year-old man sustained type II hangman’s fracture by traffic accident. Fig. 2-B. At 3 months of follow-up after anterior plate fixation, lateral radiograph revealed solid union.
Fig. 3-A, B.
49-year-old man sustained type II hangman’s fracture by traffic accident. A,B. lateral radiograph & CT scan also showed compression fracture of C3 Fig. 2-C. Posterior transpedicular screw fixation at C2, C3, and additional bridging plate fixation was done. Fig. 2-D. At 3 months follow-up, AP and bilateral radiograph showed solid union.
Fig. 4-A.
35-year-old woman sustained type II hangman’s fracture by fall down. Fig. 2 B. At 3 months follow-up after bilateral transpedicular screw fixation, lateral view showed solid union.
Fig. 5-A.
64-year-old man sustained type I-A hangman's fracture by fall down. Fig. 2-B. CT scan showed the oblique fracture of pedicle with involvement of C2 body and rotational displacement. Fig. 2-C. Lateral view showed unilateral transpedicular screw fixation.
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