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Evaluation of correction of radiological parameters (angulation and displacement) and accuracy of C2 pedicle screw placement in unstable hangman's fracture with intraoperative CT based navigation.

Research paper by Pankaj Kumar PK Singh

Indexed on: 27 Aug '17Published on: 27 Aug '17Published in: World Neurosurgery



Abstract

Opinions vary regarding optimal treatment of unstable hangman's fractures including rigid orthosis and internal fixation. The anatomy of upper cervical spine is complex. The advent of intraoperative 3-dimensional navigation systems facilitate safe and accurate instrumentation.To evaluate radiological parameters of fracture morphology in unstable hangman's fracture in preoperative and post-operative period and accuracy of inserting axis pedicle screws by using intraoperative CT based navigation..Fifteen patients with unstable hangman's fractures with age ranging from 17 years to 81 years were operated using CT-based navigation from September 2011 to march 2016. Patient's age, sex, mechanism of injury, associated injuries and neurological status were noted. Clinical outcome, accuracy of screw insertion, preoperative and postoperative displacement and angulation of C2 over C3 and bony fusion were assessed.Overall 76 screws were inserted including 30 screws in C2 pedicle with 2 (2/60 , 6.7%) malplaced screws in C2 pedicle. Mean follow-up period was 34 ± 18 months (range 7-80 months). Mean hospital stay was 12.8 ± 2.4 days. Mean preoperative and postoperative displacements were 4.1 mm and 1.8 mm respectively with a mean reduction of 2.3 mm. Mean preoperative angulation was 11.2° and the postoperative angulation was 2.1° with a mean reduction of 7.1°<b>.</b> Bony fusion was achieved and rotation was preserved at C1-C2 joint in all cases.Intraoperative O-arm-based navigation is a safe, accurate, and effective tool for screw placement in patients with unstable hangman fracture and achieves good anatomical reduction.