Interesting case that I wanted to share with the LI community. 29yo-male involved in high speed MVC rollover, sustained this unstable Hangman fracture variant. Conventional thinking would suggest that the surgical options are C1-3 PSIF or C2-3 ACDF. Given that he was quite young, I wanted to spare his atlantoaxial joint, and performed a C2-3 ACDF. However, postop I felt that this construct was unlikely to be strong enough for such an unstable injury. We subsequently did a second stage surgery involving unilateral ORIF of the C2 pars and C2-3 PSIF. 2 months out from the injury, the patient is doing great! (shared with patient permission) #spinesurgery #orthopaedics #trauma
Nice job on a tough fracture. C2-3 acdf is typically my preference to avoid fusing C1-2. Some tips I’ve learned over the years: make sure the reduction is perfect before locking the plate, longest screw possible in C2 and bicortical in C3, place C2 screws first then C3 to “reduce” it to the plate. Low threshold to augment posteriorly just like you did if I’m not very happy with the anterior fixation.
Well done! I hate C2/3 ACDF mainly for dysphagia. It's always easy to Monday Morning quarterback. I would have kept my C1 fixation less proud. For me, C1 lateral mass screws, short C2 pars screws and probably take it to C3. Tongs for reduction intraop. You did very well!
Good case and nicely done . Personally i believe bilateral c2 pedicle screws would have been better option after acdf . In Acdf starting putting from c2 then c3 body and finally c2 pedicle with c3 lat mass would have been my choice .
Great work!
Spine and Scoliosis Neurosurgeon at UCLA
1moNice reduction - very tough case. I’m a little worried about the C1-2 joint as the right parasagittal CT looks like there’s some fluid / diastasis but hopefully it holds up! Any tips / tricks on reducing the posterior elements / holding them in place to put the lag screw across (I know it’s not a real lag screw you used but same idea). Thanks for sharing