1534. Creation of a C2 pseudolamina: A salvage technique for fractured C1 lateral mass screws after fixation for an atypical Hangman’s fracture

Authors: Carlos Goulart, MD; Ziya Gokaslan; Michael Galgano (Syracuse, NY)

Introduction: Hangman’s fractures classically are described as a C2 fractures involving both pars interarticul aris . The Effendi classification system defines different grades based on varying fracture morphology. Unstable Hangman’s fractures that are treated surgically usually entail a C1-3 fixation. Less commonly, a C2/3 ACDF is employed. Methods: We present a case of a 46 year old male presenting with an unstable atypical Hangman’s fracture after an MVC. He had a previous history of 3 prior anterior / posterior spine surgeries in the past. Results: We took the patient to the OR for an extension of his previous posterior cervical fusion up to C1, bypassing C2 due to the comminuted nature of the fractures. His neck pain improved significantly after surgery, and was discharged on POD #2. Six weeks after surgery, he once again presented with severe neck pain. The patient was non-compliant with his C-collar, and turned his head quickly while driving a car. He felt sudden severe neck pain upon doing this. A new CT scan revealed bilateral fractures of the C1 lateral mass screws. We took the patient back to surgery and created C2 pseudolamina utilizing a standard rod in the horizontal plane connected to the other vertical rods via a J-hook. Two sublaminar wires were then passed underneath the posterior arch of C1. An additional sublaminar wire was placed through the posterior C1 tubercle after drilling a hole though it. The three sublaminar wires attached to C1 were then tightened and secured to the C2 pseudolamina. Conclusion: Fractured C1 screws are a relatively uncommon occurrence within the first few weeks of surgery. The technique described is a reasonable salvage maneuver to avoid an occipital-cervical fusion in such a situation.