Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Between 1999 and 2004, 28 patients (average age: 41, range: 18–70 years) with unstable hangman’s fracture underwent anterior discectomy and fusion with internal fixation at our unit. According to the Levine-Edwards classification, all cases were unstable with type II (10 cases), type IIA (17 cases) and type III (1 case). An average follow-up of 15 months was achieved (range: 3–48 months). The average operative time was 107 min (80–131 min). No patient received blood transfusion. No patient experienced worsening neurological function postoperatively. No other intra- or postoperative complication was observed. All patients were relieved from axial pain. Neurological status improved postoperatively in all four cases with neurological deficit. Each patient showed evidence of a solid anterior C2–3 interbody fusion after six months. No bone graft or plate screws complication was observed in any of the cases during the follow-up period. In our experience the anterior approach with primary internal stabilisation may be a feasible and safe method to treat unstable hangman’s fracture.