Pedicle screw instrumentation of the upper cervical spine is rarely performed in trauma surgery because of the risk of damaging neurovascular structures. We report successful treatment of an unstable hangman's fracture with posterior pedicle screw fixation using Iso-C3D fluoroscopy-based computer navigation guidance. Postoperative computed tomographic images confirmed accurate placement of the pedicle screws. The navigation system is useful, especially in an unstable upper cervical spine injury where the likelihood of change in the inter-segmental relationship is maximal before and after positioning for surgery. The navigation system has the advantage of data acquisition after patient positioning, thus making safe pedicle fixation of the C1 and C2 vertebrae possible despite fractured posterior elements.
HellerJGSilcoxDH3rdSutterlinCE3rd. Complications of posterior cervical plating. Spine1995;20:2442–8.
2.
BorneGMBedouGLPinaudeauM. Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg1984;60:88–93.
3.
Roy-CamilleRSalientGMazelC. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. In: The Cervical Spine Research Society, editor. The cervical spine. 2nd ed.Philadelphia: JB Lippincott; 1989:390–403.
4.
Roy-CamilleRMazelCSaillantGBenazetJP. Rationale and techniques of internal fixation in trauma of the cervical spine. In: ErricoTBauerRDWaughT, editors. Spinal trauma. Philadelphia: JB Lippincott; 1991:163–91.
Placement of pedicle screws in the human cadaveric cervical spine: Comparative accuracy of three techniques. Spine2000;25:1655–67.
7.
RichterMMattesTCakirB. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J2004;13:50–9.
8.
LudwigSCKowalskiJMEdwardsCC2ndHellerJG. Cervical pedicle screws: Comparative accuracy of two insertion techniques. Spine2000;25:2675–81.
9.
KamimuraMEbaraSItohHTateiwaYKinoshitaTTakaokaK. Accurate pedicle screw insertion under the control of a computer-assisted image guiding system: Laboratory test and clinical study. J Orthop Sci1999;4:197–206.
10.
GreeneKADickmanCAMarcianoFFDrabierJBHadleyMNSonntagVK. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine1997;22:1843–52.
11.
HadleyMNSonntagVKGrahmTWMasferrerRBrownerC. Axis fractures resulting from motor vehicle accidents. The need for occupant restraints. Spine1986;11:861–4.
12.
EffendiBRoyDCornishBDussaultRGLaurinCA. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br1981;63:319–27.
13.
LevineAMEdwardsCC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am1985;67:217–26.
14.
MullerEJWickMMuhrG. Traumatic spondylolisthesis of the axis: Treatment rationale based on the stability of the different fracture types. Eur Spine J2000;9:123–8.
15.
McAfeePCBohlmanHH. One-stage anterior cervical decompression and posterior stabilization with circumferential arthrodesis. A study of twenty-four patients who had a traumatic or a neoplastic lesion. J Bone Joint Surg Am1989;71:78–88.
16.
KotaniYCunninghamBWAbumiKMcAfeePC. Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine1994;19:2529–39.
17.
UlrichCWoersdoerferOKalffRClaesLWilkeHJ. Biomechanics of fixation systems to the cervical spine. Spine1991;16(3 Suppl):S4–9.
18.
AbumiKPanjabiMMDuranceauJ. Biomechanical evaluation of spinal fixation devices. Part III. Stability provided by six spinal fixation devices and interbody bone graft. Spine1989;14:1249–55.
19.
CoeJDWardenKESutterlinCE3rdMcAfeePC. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine1989;14:1122–31.
20.
KaraikovicEEDaubsMDMadsenRWGainesRWJr. Morphologic characteristics of human cervical pedicles. Spine1997;22:493–500.
21.
EbraheimNRollinsJRJrXuRJacksonWT. Anatomic consideration of C2 pedicle screw placement. Spine1996;21:691–5.
GebhardFWeidnerALienerUCStockleUArandM. Navigation at the spine. Injury2004;35(Suppl 1):S-A35–45.
24.
ArandMKinzlLGebhardF. Sources of error and risks in CT based navigation [in German]. Orthopade2002;31:378–84.
25.
HottJSPapadopoulosSMKlopfensteinJD. Image guidance in spinal surgery for trauma: Iso-C 3D. Operative techniques in neurosurgery. 2004;7:42–7.
26.
HottJSPapadopoulosSMTheodoreNDickmanCASonntagVK. Intraoperative Iso-C C-arm navigation in cervical spinal surgery: Review of the first 52 cases. Spine2004;29:2856–60.
