Percutaneous Screw Fixation for Traumatic Spondylolisthesis of the Axis Using Iso-C3D Fluoroscopy-Assisted Navigation (Case Report)

Introduction: Stable hangman's fractures are usually treated with a Halo vest fixation; however, this is not always effective in patients with polytrauma. These patients benefit from minimally invasive surgery because it allows for early rehabilitation and reduced nursing care. This is the case report on percutaneous screw fixation using three dimensional fluoroscopy-assisted navigation in a patient with polytrauma and a hangman's fracture. Case Report: The patient was a 69-year-old woman involved in a traffic accident. Radiographs and CT showed bilateral fractures through the neural arch at the base of the C2 pedicles. External immobilzation was difficult due to her polytrauma. Intervention: A dynamic reference arc was attached to the spinous process of the axis through a small incision. After image acquisition, the fluoroscope workstation generated 3-dimensional reconstructions of the imaged anatomy. We made two small, lateral incisions for percutaneous screw insertion, and used an image-guided awl to create screw holes. A guide-wire was inserted through this screw pilot hole, and a cancellous lag screw was inserted over the guide-wire. At her final follow-up, the patient had no neurological deficits and bony union was achieved. Conclusion: Percutaneous screws fixation using three-dimensional fluoroscopy proved to be a useful technique for the treatment of hangman's fracture.