Minimally Invasive Percutaneous Screw Fixation of Traumatic Spondylolisthesis of the Axis

Presented at SMISS Annual Forum 2013
By Avery Buchholz MD, MPH

Disclosures: Avery Buchholz MD, MPH None

Introduction: Most cases of traumatic spondylolisthesis of the Axis (Hangman’s fracture) can be treated non-operatively with reduction and subsequent immobilization in a rigid cervical collar or HALO. However, in some instances operative management is necessary and can be accomplished using either anterior or posterior fusion techniques. Because open posterior procedures can result in significant blood loss, morbidity and limited cervical range of motion, other less invasive options for posterior fixation are important to develop. Here we describe a minimally invasive, navigation guided, technique for surgical treatment of Levine-Edwards Type II Hangman’s fractures.

Methods: Five patients with Types II Hangman’s fractures requiring operative reduction and internal fixation were treated using percutaneous lag screws directed through the fracture site at the pars interarticularis. This technique is facilitated using intraoperative 3-D fluoroscopy and neuronavigation.

Results: Five patients (2 female 3 male), ages (range: 46-67) were operatively treated for Levine-Edwards type II Hangman’s fractures. There were no intraoperative or postoperative complications. All patients were maintained in a hard collar and then flexion extension x-rays were obtained at 6 months. All patients demonstrated a stable construct upon dynamic imaging and c-collar was discontinued.

Conclusion: Levine-Edwards type II Hangman’s fractures can be safely repaired using percutaneous MIS techniques. Potential advantages include: minimal scar, decreased disruption of paraspinal muscle, maintenance of normal ROM, decreased blood loss, decreased pain, decreased LOS, faster return to work, and decreased length of operation. This technique is not appropriate for Type III fractures with significant ligamentous injury and disc disruption and was not directly evaluated for Type IIa fractues. Based on our results, Levine-Edwards Types I and II Hangman’s fractures may be safely and effectively treated using this MIS technique.