Polyetheretherketone cage for treating type II and type IIa Hangman’s fractures: 6-month follow-up

doi:10.3969/j.issn.2095-4344.2015.39.013

Abstract

Abstract:

BACKGROUND: Unstable cases of Hangman’s fracture or traumatic spondylilisthesis which are type II, IIa and III should be treated surgically. Retropharyngeal approach was employed in exposure of anterior upper cervical region. However, dissection and traction around important structures make the procedure complicated and increase the chance of nerve injury.
OBJECTIVE: To evaluate the clinical curative effect and safety of an innovative operative technique in which a polyetheretherketone cage was used to perform cervical spinal fusion for the treatment of Hangman’s fracture.
METHODS: Eight patients with type II or IIa Hangman’s fracture were enrolled in this study and received cervical fusions at C2/3 levels. During follow-up postoperatively, they received X-ray examination. Fusion time and implant position were evaluated. The angle of deformity (α) and the displacement distance (β) were compared pre-operatively and 6-month post-operatively to measure reduction. The functional outcomes were also compared using the Post-Traumatic Neck Score (Mayo) pre-operatively and 6-month post-operatively, while neck pain was further investigated by Visual Analogue Scale score.
RESULTS AND CONCLUSION: All eight patients were followed-up successfully, with an average follow-up of 13 months (range 6-26 months). Compared with pre-operatively, Clinical Post-Traumatic Neck Score (Mayo) was increased, Visual Analogue Scale score, angle deformity (α) and displacement distance (β) were reduced at 6-month post-operatively (P < 0.05). Neck activity was not limited in final follow-up. Bone fusion was found in all patients at 3 or 6 months post-operatively, and no complication was detected. Results confirm that polyetheretherketone cage for type II and IIa Hangman’s fracture could achieve good outcomes and safety.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tissue Engineering, Spine, Fractures, Bone, Intervertebral Disk

CLC Number:

R318

Huang Yang-liang, Zhong Yi, Liu Shao-yu. Polyetheretherketone cage for treating type II and type IIa Hangman’s fractures: 6-month follow-up[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2015.39.013.

Figures/Tables 2

Quantitative analysis of participants Eight patients were collected at the beginning, and they were all successfully follow-up for 6 months or longer. None of them was lost, so their data were put into final statistical analysis. Clinical results The mean operative time was 97.0±21.4 minutes (range 70-135) and the mean hemorrhage amount was 31±10.5 mL (range 20-50). We did not observe transient or permanent hoarseness, dysphagia and dysphonia. By Smith and Robinson approach, lower part of axis body could be exposed without difficulty in all of our patients. There were no further operations. Of the total 8 consecutive patients, follow-up evaluation data of 6 months or longer were available for all patients at a mean clinical follow-up of 13.0±6.21 months (range 6-26). The Clinical Post-Traumatic Neck Score (Mayo) was 51.88±7.38 (range 45-63) pre-operatively and 90.75±4.68 (range 83-95) at 6-month follow-up. There was a significant improvement (P=0.001). The pre-operative VAS scale score was 7.00±0.76 (range 6-8) and 6-month post-operative score was 1.13±0.64 (range 0-2). There was a significant difference between pre and post-operative results (P < 0.001) (Table 2). In our 6-month post-operative questionnaires of Neck Score, no patients complained of cervical movement limitation that disturbed daily activities; and cervical pain was relieved, no further oral analgesics were needed. On last follow-up, there was no cervical pain recorded either. Radiographic results Cervical radiograph examinations performed at the last follow-up visits showed no subsidence, collapse, breaking, or pseudarthrosis at the level of the implants. There was no bone material absorption or necrosis at the contiguous vertebral bodies, and no noticeable inflammatory reaction. There were no lucency gaps between fracture lines. Fusion was observed after 3 or 6 months in all of our patients. The mean of angle deformity (α) pre-operatively was -7.50±8.05, and 6-month post-operatively was 5.00±6.52; the difference was significant (P=0.007). The mean of displacement distance (β) pre-operatively was 2.81±1.49, and 6-month post-operatively was 0.94±0.68, which was significant either (P=0.002) (Table 2)."

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