{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T20:39:45Z","timestamp":1771706385430,"version":"3.50.1"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Most cases of traumatic spondylolisthesis of the axis (hangman's fracture) can be treated nonoperatively with reduction and subsequent immobilization in a rigid cervical collar or halo. However, in some instances, operative management is necessary and can be accomplished by using either anterior or posterior fusion techniques. Because open posterior procedures can result in significant blood loss, pain, and limited cervical range of motion, other less invasive options for posterior fixation are needed. The authors describe a minimally invasive, navigation-guided technique for surgical treatment of Levine-Edwards (L-E) Type II hangman's fractures.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>For 5 patients with L-E Type II hangman's fracture requiring operative reduction and internal fixation, percutaneous screw fixation directed through the fracture site was performed. This technique was facilitated by use of intraoperative 3D fluoroscopy and neuronavigation.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of the 5 patients, 2 were women, 3 were men, and age range was 46\u201367 years. No intraoperative or postoperative complications occurred. All patients wore a rigid cervical collar, and flexion-extension radiographs were obtained at 6 months. For all patients, dynamic imaging demonstrated a stable construct.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>L-E type II hangman's fractures can be safely repaired by using percutaneous minimally invasive surgical techniques. This technique may be appropriate, depending on circumstances, for all L-E Type I and II hangman's fractures; however, the degree of associated ligament injury and disc disruption must be accounted for. Percutaneous fixation is not appropriate for L-E Type III fractures because of significant displacement and ligament and disc disruption. This report is meant to serve as a feasibility study and is not meant to show superiority of this procedure over other surgical options.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.spine131168","type":"journal-article","created":{"date-parts":[[2015,2,27]],"date-time":"2015-02-27T15:01:17Z","timestamp":1425049277000},"page":"459-465","source":"Crossref","is-referenced-by-count":27,"title":["Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis"],"prefix":"10.3171","volume":"22","author":[{"given":"Avery Lee","family":"Buchholz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven L.","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie C.","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce M.","family":"Frankel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2 Suppl","key":"b1-spine131168","series-title":"J Neurosurg","first-page":"227","article-title":"Direct anterior screw fixation for recent and remote odontoid fractures","volume":"93","author":"Apfelbaum","year":"2000"},{"key":"b2-spine131168","series-title":"Clin Biomech (Bristol, Avon)","first-page":"432","article-title":"The traumatic spondylolisthesis of the axis. A biomechanical in vitro evaluation of an instability model and clinical relevant constructs for stabilization","volume":"17","author":"Arand","year":"2002"},{"key":"b3-spine131168","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"88","DOI":"10.3171\/jns.1984.60.1.0088","article-title":"Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique","volume":"60","author":"Borne","year":"1984"},{"issue":"3B","key":"b4-spine131168","series-title":"Arq Neuropsiquiatr","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1590\/S0004-282X2004000500015","article-title":"Surgical management of axis' traumatic spondylolisthesis (Hangman's fracture)","volume":"62","author":"Boullosa","year":"2004"},{"key":"b5-spine131168","series-title":"Neurosurgery","first-page":"E204","article-title":"Pars screw fixation of a hangman's fracture: technical case report","volume":"56","author":"Bristol","year":"2005"},{"key":"b6-spine131168","series-title":"Spine (Phila Pa 1976)","first-page":"285","article-title":"Re: Yoshida et al. Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw","volume":"32","author":"Cacciola","year":"2007"},{"key":"b7-spine131168","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3171\/2009.4.SPINE08516","article-title":"Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques","volume":"11","author":"Chittiboina","year":"2009"},{"key":"b8-spine131168","series-title":"Turk Neurosurg","first-page":"163","article-title":"Traumatic spondylolisthesis of the axis treated with direct C2 pars screw","volume":"19","author":"Dalbayrak","year":"2009"},{"key":"b9-spine131168","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1097\/00007632-199603150-00005","article-title":"Anatomic consideration of C2 pedicle screw placement","volume":"21","author":"Ebraheim","year":"1996"},{"key":"b10-spine131168","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1302\/0301-620X.63B3.7263741","article-title":"Fractures of the ring of the axis. A classification based on the analysis of 131 cases","volume":"63-B","author":"Effendi","year":"1981"},{"key":"b11-spine131168","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1007\/s00586-010-1401-2","article-title":"Transpedicular screw fixation for type II Hangman's fracture: a motion preserving procedure","volume":"19","author":"ElMiligui","year":"2010"},{"issue":"239","key":"b12-spine131168","series-title":"Clin Orthop Relat Res","first-page":"47","article-title":"Traumatic spondylolisthesis of the axis","author":"Fielding","year":"1989"},{"key":"b13-spine131168","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"509","DOI":"10.3171\/2009.11.SPINE09172","article-title":"Posterior occipitocervical (C0\u20133) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis","volume":"12","author":"Frankel","year":"2010"},{"key":"b14-spine131168","series-title":"Neurochirurgie","first-page":"25","article-title":"[Traumatic spondylolisthesis of the axis: arguments in favor of surgical management after analysis of 8 patients]","volume":"49","author":"Fuentes","year":"2003"},{"key":"b15-spine131168","series-title":"Neurol Neurochir Pol","first-page":"28","article-title":"Operative treatment of hangman's fractures of C2. Posterior direct pars screw repair or anterior plate-cage stabilization?","volume":"42","author":"Haka\u0142o","year":"2008"},{"key":"b16-spine131168","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2856","DOI":"10.1097\/01.brs.0000147742.20637.49","article-title":"Intraoperative Iso-C C-arm navigation in cervical spinal surgery: review of the first 52 cases","volume":"29","author":"Hott","year":"2004"},{"key":"b17-spine131168","series-title":"Fractures du Rachis Cervical","first-page":"174","article-title":"Actualit\u00e9s de chirurgie orthop\u00e9dique de l'Hospital Raymond-Poin car\u00e9","author":"Judet","year":"1970"},{"key":"b18-spine131168","series-title":"Luxation Cong\u00e9nitale de la Hanche. Fractures du Cou-de-pied Rachis Cervical. Actualit\u00e9s de Chirurgie Orthop\u00e9dique de L'H\u00f6pital Raymond-Poincar\u00e9","first-page":"147","article-title":"Fracture et luxation des deux premi\u00e8res vert\u00e8bres cervicales","author":"Leconte","year":"1964"},{"key":"b19-spine131168","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2106\/00004623-198567020-00007","article-title":"The management of traumatic spondylolisthesis of the axis","volume":"67","author":"Levine","year":"1985"},{"key":"b20-spine131168","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s00586-005-0918-2","article-title":"A systematic review of the management of hangman's fractures","volume":"15","author":"Li","year":"2006"},{"key":"b21-spine131168","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1097\/00007632-200007010-00009","article-title":"Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques","volume":"25","author":"Ludwig","year":"2000"},{"key":"b22-spine131168","series-title":"Bull Hosp Jt Dis","first-page":"61","article-title":"Traumatic spondylolisthesis of the axis: 42 cases","volume":"60","author":"Moon","year":"2001"},{"key":"b23-spine131168","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s005860050222","article-title":"Traumatic spondylolisthesis of the axis: treatment rationale based on the stability of the different fracture types","volume":"9","author":"M\u00fcller","year":"2000"},{"key":"b24-spine131168","series-title":"J Orthop Surg (Hong Kong)","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1177\/230949900701500116","article-title":"Intra-operative Iso-C3D navigation for pedicle screw instrumentation of hangman's fracture: a case report","volume":"15","author":"Rajasekaran","year":"2007"},{"issue":"6","key":"b25-spine131168","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Image-injected frameless stereotactic approach to the anterior craniovertebral junction","volume":"6","author":"Ryken","year":"1999"},{"key":"b26-spine131168","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"141","DOI":"10.3171\/jns.1965.22.2.0141","article-title":"\u201cHangman's fracture\u201d of the cervical spine","volume":"22","author":"Schneider","year":"1965"},{"key":"b27-spine131168","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"569","DOI":"10.3171\/2013.8.SPINE12948","article-title":"Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures. Clinical article","volume":"19","author":"Shin","year":"2013"},{"key":"b28-spine131168","series-title":"J Neurosci Nurs","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/01376517-200802000-00006","article-title":"The multiple benefits of minimally invasive spinal surgery: results comparing transforaminal lumbar interbody fusion and posterior lumbar fusion","volume":"40","author":"Starkweather","year":"2008"},{"key":"b29-spine131168","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1097\/01.bsd.0000193820.42522.d9","article-title":"Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies","volume":"19","author":"Stevens","year":"2006"},{"issue":"3 Suppl","key":"b30-spine131168","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1227\/01.NEU.0000320434.83458.10","article-title":"Minimally invasive posterior fixation","volume":"63","author":"Wang","year":"2008"},{"key":"b31-spine131168","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1097\/00007632-197803000-00003","article-title":"The basic kinematics of the human spine. A review of past and current knowledge","volume":"3","author":"White","year":"1978"},{"key":"b32-spine131168","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s00586-012-2578-3","article-title":"Management of hangman's fracture with percutaneous transpedicular screw fixation","volume":"22","author":"Wu","year":"2013"},{"key":"b33-spine131168","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1097\/BRS.0b013e31816233d0","article-title":"Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis","volume":"33","author":"Ying","year":"2008"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/5\/article-p459.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/5\/article-p459.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/5\/article-p459.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T21:25:55Z","timestamp":1681593955000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/5\/article-p459.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":33,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2014.10.spine131168","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2015,5]]}}}