Anterior cervical discectomy and fusion versus posterior fixation and fusion of C2-3 for unstable hangman's fracture.

Study Design: This was a retrospective study. Objective: To compare the efficacy and safety between anterior cervical discectomy and fusion (ACDF) and posterior fixation and fusion (PFF) for treating unstable hangman's fracture. Summary of Background Data: In previous clinical study, ACDF and PFF have been introduced to manage unstable hangman's fracture. However, it remains unknown which approach is superior. Methods: Between January 2006 and May 2011, 44 patients with unstable hangman's fracture underwent either ACDF or PFF. The operation time, blood loss, surgical complications, and postoperative drainage were compared. Neurologic function was evaluated using the ASIA scale and neck pain was assessed using the Visual Analogue Scale (VAS) score. Rates of fracture heeling and bone fusion were also studied. Results: Follow-up was completed for 38 patients. Twenty-four cases underwent ACDF and 14 cases received PFF. The operation was successful in all 38 cases. The mean operative time, estimated blood loss, and postoperative drainage were significantly shorter or less for the ACDF group than the PFF group (P < 0.01). No surgical complication was reported in the ACDF group. Excessive bleeding due to injury to the venous plexus occurred in 3 cases in the PFF group. The VAS score in the 2 groups was significantly lower than their respective preoperative score (P < 0.01), but there was no difference between the 2 groups (P > 0.05). Solid fusion was achieved with no implant failure in all cases 6 months postoperatively. At the final follow-up, 8 cases with ASIA C or D grade improved to E grade. Conclusions: The anterior procedure seems to be superior to the posterior approach for unstable hangman's fracture as it is a less invasive and simpler procedure with fewer complications and is especially indicated for cases with no medullary canal in C2 pedicles and traumatic C2-3 disk herniation compressing the spinal cord.