Anterior C3 corpectomy and fusion for complex Hangman's fractures

The aim of this study was to assess the effectiveness and feasibility of anterior C3 corpectomy and fusion with screw-plate fixation of C2-4 for the treatment of Hangman's fracture in which spinal cord compression comes from the posterosuperior part of C3 vertebral body and the intervertebral disc injury at the C2-3 level.

From August 2000 to December 2005, 11 patients (eight males and three females) with traumatic spondylolisthesis of the axis underwent the above surgery. Neurological status was evaluated by the Japanese Orthopaedic Association Score (JOA score). The fusion of the graft, healing of the fracture, and range of motion of the whole cervical spine were examined according to X-ray imaging.

No patient received blood transfusion. There was no deterioration of the neurological function in any case postoperatively. The mean JOA score was significantly improved from 9.1 ± 2.3 preoperatively to 14.8 ± 1.2 at the 12-month postoperative visit. All patients were relieved of axial pain. Imaging evaluation confirmed a high fusion rate and healing rate in all patients. No patient complained of limited mobility of the cervical spine in flexion, extension and rotation. No graft or plate-related complication was observed in any patients during the whole follow-up period. The only postoperative complication was trouble in swallowing liquids in two cases which resolved three months after surgery without any treatment.

Anterior C3 corpectomy and fusion may prove to be safe and applicable for the treatment of complex Hangman's fractures.