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Fixation Rather Than Fusion of Hangman's Fracture Now Possible

Fractures of the upper cervical spine (neck) can be very difficult to treat. The bones in the area are small. Swelling and bone fragments complicate the problem.

CT scans taken before the operation don't show the same anatomical positions that are present during the procedure. This is because the patient is supine (on the back) for the CT scan. But the surgery is done with the patient face down. This position gives the surgeon access to the spine.

A new computer navigation imaging system called Iso-C 3D may help. In this case report, surgeons from India successfully fused the C2 vertebrae in one adult patient using Iso-C 3D-based fluoroscopy. This type of imaging allows the surgeon to see the spine's position as it is at that exact moment. This is referred to as intraoperative real-time imaging.

The 28-year-old male manual laborer fell and fractured both sides of the pedicles (posterior segment) of his C2 vertebra. The C2 vertebra shifted forward over the C3 vertebra below it. This type of injury is called a Hangman's fracture. Surgery was needed to realign and reconnect the vertebrae.

The real-time imaging assisted by computer navigation made it possible to get an accurate picture of the spine. The exact entry point was found. The surgeon could use this imaging tool to make sure the position of the screws was correct.

This special imaging aid made it possible to put screws in place without puncturing a blood vessel or entering the spinal canal. This injury could be stabilized without fusing the neck. Fusion results in loss of neck motion.

Successful fixation of this area is now possible with the Iso-C 3D fluoroscopy navigation system. The authors note that the equipment is expensive. It is not available everywhere. Patients may be exposed to more radiation than is desired.

References: S. Rajasekaran, MS, DNB, MCh, FRCS, FACS, PhD, et al. Iso-C(3D) Fluoroscopy-Based Navigation in Direct Pedicle Screw Fixation of Hangman Fracture. A Case Report. In Journal of Spinal Disorders and Techniques. December 2007. Vol. 20. No. 8. Pp. 616-619.

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