Article Figures & Data
Figures
- Figure 1
Lateral plain x-ray image of a patient with hangman’s fracture with visible anterior translation of the C2 vertebral body and fracture through the pars interarticularis. Reprinted with permission from Gaillard F. Hangman fracture. Case study, Radiopaedia.org. https://doi.org/10.53347/rID-36014.
- Figure 2
Transverse, sagittal, and parasagittal computed tomographic images of a 25-year-old woman in a road traffic accident. Note the asymmetry of pars interarticularis fractures. Source: Dixon A. Hangman fracture. Case study, Radiopaedia.org. https://doi.org/10.53347/rID-10130.
- Figure 3
Illustration of hangman fractures by Levine and Edwards classifications. Reprinted with permission from Hacking C. Levine and Edwards classification of hangman fractures (diagrams). Case study, Radiopaedia.org. https://doi.org/10.53347/rID-88380
- Figure 4
A preferred reporting items for systematic reviews and meta-analyses flowchart.
- Figure 5
Surgical approach by fracture classification. MIS, minimally invasive surgery; DPS, direct pedicle screw.
- Figure 6
Pre- and postoperative visual analog scale (VAS) scores by surgical techniques displayed as line graph. ACDF, anterior cervical discectomy and fusion; pre-op, preoperative; post-op, postoperative.
- Figure 7
Blood loss in milliliters by surgical approach, number of patients.
- Figure 8
Lateral x-ray image of patient from Figure 2 who has had an anterior cervical discectomy and fusion procedure. Reprinted with permission from Dixon A. Hangman fracture. Case study, Radiopaedia.org. https://doi.org/10.53347/rID-10130 https://doi.org/10.53347/rID-10130
Tables
Author Year Surgical Approach Operation n Mean Age, y Type Chowdhury & Haque11 2014 Posterior C1-C3 lateral mass fusion 6 40.8 Prospective Dalbayrak et al25 2009 Posterior C2 DPS 2 24 Prospective Posterior C2-C3 fusion 2 45 Prospective Li et al26 2007 Posterior C2-C3 fusion 20 43.5 Retrospective Posterior C1-C3 pedicle fusion 4 48 Retrospective Anterior ACDF 1 34 Retrospective Combined 2 42 Retrospective Singh et al15 2014 Posterior C2-C3 pedicle fusion 10 36.6 Prospective Lang et al19 2016 Posterior C2-C3 pedicle MIS 6 36.5 Retrospective Posterior C2-C3 pedicle 14 34.5 Retrospective Kong et al12 2020 Anterior ACDF 46 43 Retrospective Jin et al27 2020 Anterior ACDF 20 44.7 Retrospective Posterior C1-C3 pedicle fusion 25 48 Retrospective Ying et al17 2008 Anterior ACDF 30 32 Retrospective Li et al23 2015 Anterior ACDF 38 42.8 Retrospective Rajasekaran et al28 2012 Posterior C2 DPS, navigation 20 38 Prospective Taller et al29 2000 Posterior C2 DPS, navigation 10 44.8 Retrospective Boullosa et al30 2004 Posterior C2-C3 pedicle fusion 10 35.6 Prospective Park et al31 2007 Anterior ACDF 11 41.8 Retrospective Xu et al32 2010 Anterior ACDF 28 41 Retrospective ElMiligui et al33 2010 Posterior C2 DPS 15 37 Prospective Ma et al34 2010 Posterior C2-C3 fusion 35 45 Retrospective Tian et al35 2012 Posterior C2-C3 pedicle screw fusion 14 38.2 Retrospective Wang et al36 2013 Anterior C3 corpectomy + fusion with screw + plate C2-C4 11 34 Retrospective Wu et al37 2012 Posterior C2 DPS, MIS 10 50.8 Retrospective El Harawy38 2013 Posterior C2 DPS 9 35.7 Retrospective Liu et al39 2013 Combined 13 39.4 Retrospective Salunke et al40 2018 Posterior C2-C3 fusion 9 42.4 Prospective Li et al23 2018 Posterior C2-C3 fusion 23 42.7 Retrospective Prost et al16 2019 Anterior ACDF 4 Prospective Posterior C2-C3 fusion 7 Prospective Patel et al18 2020 Anterior ACDF 12 39.8 Retrospective Posterior C2-C3 pedicle screw fusion 9 41.3 Retrospective Man Kyu et al41 2019 Posterior C2 DPS, MIS 7 51.3 Retrospective Liu et al42 2020 Posterior C2 DPS 25 45.4 Prospective Seo et al43 2021 Anterior ACDF 5 40.4 Retrospective Hur et al44 2013 Anterior ACDF 17 51 Retrospective Wang et al36 2014 Posterior C1-C2 fusion 5 44.8 Retrospective Ge et al45 2015 Anterior ACDF 24 36.5 Retrospective Posterior C2-C3 pedicle screw fusion 14 39.6 Retrospective Wei et al46 2015 Anterior ACDF 28 39.2 Retrospective Anterior ACDF with cage 21 42.5 Retrospective Buchholz et al47 2015 Posterior C2 DPS, MIS 5 55 Retrospective Wei et al48 2015 Anterior ACDF with cage 15 36.8 Prospective Wang et al36 2015 Combined 11 39 Retrospective Jain et al49 2017 Anterior ACDF 44 Retrospective Abbreviations: ACDF, anterior cervical discectomy and fusion; DPS, direct pedicle screw; MIS, minimally invasive surgery.
VAS Score Surgical Technique Number Preoperative Postoperative Difference Minimally invasive surgery 13 6.4 0.9 −5.5 C2 direct pedicle screw 47 7.6 1.9 −5.7 C2-C3 fusion 71 5.8 1.5 −4.3 Anterior cervical discectomy and fusion 163 6.8 2.3 −4.5 Abbreviation: VAS, visual analog scale.
Variable Posterior Approach Anterior Approach Combined Approach Minimally Invasive n 254 Patients 314 Cases 26 Cases 21 Cases Complications 2 Surgical site infections
3 Metalwork-related infections
5 Lung/urine infections
5 Cases of severe bleeding intraoperatively
1 Transient cerebral ataxia2 Surgical site infections
2 Local hematoma
3 Voice alterations
6 Donor site pain
16 Dysphagia
3 Transient cerebral ataxia1 Thoracic perforation
1 Dysphagia0 Reported complications Operation Type n Mean Operating Time, min Posterior fusion 149 126.2 Minimally invasive surgery 28 95 Direct pedicle screw 50 99.4 Anterior cervical discectomy and fusion 271 98.9 Combined 24 211.7
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