C1-C3 lateral mass fusion for type IIa and type III Hangman's fracture
A 22-year-old male was the unrestrained passenger in a vehicle involved in road traffic accident. Shortly, after the accident, he complained of severe neck pain. When examined in the hospital, he had no neurological deficits, but had severe pain and tenderness in the neck. His radiographs showed a type III Levine and Edwards Hangman's fracture []. His MRI of the spine showed hematoma extending from the clivus to C4 along with anterior translation and angulation of C2 over C3 along with disruption of the C2-C3 disc []. CT of the spine showed bilateral pars fracture of C2 with significant displacement []. In view of these findings, anterior approach with C2-C3 discectomy and plating was planned. With the patient under traction, the C2-C3 region was exposed through the anterolateral approach and discectomy and grafting of C2-C3 was carried out. However, attempt to plate C2 and C3 was not successful as the diameter of the available plate was greater than the diameter of the base of C2 body as was cautioned by Traynelis and Fontes.[] Hence, grafting alone was carried out. However, post-operative radiographs on day 2 revealed dislodgment of the graft with recurrence of subluxation. Hence, patient was taken up for posterior C1-C3 lateral mass fusion. The same approach as mentioned for case 1 was carried out uneventfully []. Post-operative radiographs showed good alignment with appropriate position of the screws []. Three months later, patient had no neurological deficits, but had a small trophic ulcer in the occipital region owing to numbness in the area and wearing of Philadelphia collar.