Is Anterior Cervical Discectomy and Fusion Sufficient for Neglected Unstable Hangman's Fracture? A Retrospective Case Series of Five Patients.

IF 1.2 Q3 SURGERY
Spine Surgery and Related Research Pub Date : 2024-03-11 eCollection Date: 2024-07-27 DOI:10.22603/ssrr.2023-0231
Dhiraj V Sonawane, Harshit Dave, Shivaprasad S Kolur, Ajay Chandanwale, Sagar A Jawale, Naved Ahmed F Ansari
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引用次数: 0

Abstract

Introduction: This study investigates the outcomes of treating neglected unstable Hangman's fractures through a single-stage Anterior Cervical Discectomy and Fusion (ACDF) procedure with tricortical iliac crest bone grafts.

Methods: Five patients with neglected unstable Hangman's fractures, treated at our institution between March 2012 and March 2017, underwent C2-C3 ACDF. Functional outcomes were assessed using the Visual Analog Scale (VAS) score and Neck Disability Index (NDI), and neurological evaluation was done using the American Spinal Injury Association (ASIA) grading system. The radiological assessment included serial plain radiographs and a computed tomography scan at a 12-month follow-up.

Results: Postoperatively, C2-C3 angulation improved significantly, decreasing from 15° to 4.4°, and sagittal translation improved from 4.2 mm to 2 mm. The VAS score improved from 6.4 to 1.4 at 24 months postsurgery. Concurrently, NDI decreased from 70.4% to 14.8%. Fusion occurred in an average of 5.6 months. Neurologically, one patient improved from ASIA grade D to grade E, while the other four retained their grade E status.

Conclusions: A single-stage ACDF with autologous iliac crest bone grafts is an effective surgical option for neglected type II/IIA Hangman's fractures, yielding satisfactory functional and radiological outcomes. This technique significantly corrects anterior translation and angulation, even in neglected cases, with the aid of intraoperative skull traction and plate reduction.

颈椎前路椎间盘切除和融合术是否足以治疗被忽视的不稳定刽子手骨折?五例患者的回顾性病例系列。
导言:本研究探讨了采用三皮质髂嵴植骨的单阶段颈椎前路椎间盘切除与融合术(ACDF)治疗被忽视的不稳定型刽子手骨折的效果:2012年3月至2017年3月期间,在我院接受治疗的5例被忽视的不稳定型Hangman骨折患者接受了C2-C3 ACDF手术。采用视觉模拟量表(VAS)评分和颈部残疾指数(NDI)评估功能结果,采用美国脊柱损伤协会(ASIA)分级系统进行神经评估。放射学评估包括连续平片和 12 个月随访时的计算机断层扫描:术后,C2-C3 成角明显改善,从 15° 下降到 4.4°,矢状面平移从 4.2 mm 下降到 2 mm。术后24个月时,VAS评分从6.4分降至1.4分。同时,NDI从70.4%降至14.8%。融合平均在 5.6 个月后完成。在神经系统方面,一名患者从ASIA D级提高到E级,而其他四名患者则保持了E级状态:结论:使用自体髂嵴植骨的单期 ACDF 是治疗被忽视的 II/IIA 型刽子手骨折的有效手术方案,可获得令人满意的功能和影像学结果。该技术借助术中颅骨牵引和钢板复位,即使在被忽视的病例中也能明显纠正前移和成角。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
71
审稿时长
15 weeks
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