The neurosurgical management in a rare case of vertical axis fracture is presented
along with discussion of the supposed pathogenetic mechanisms and the biomechanics
underlying this type of cervical spine injury. Comprehensive neuroradiological investigation
prior to surgery clearly demonstrated the dislocation of the anterior part of the
axis body with concomitant C 2/C 3-disk injury. Therefore, the unstable fracture had
to be managed by a one-time combined ventrodorsal approach using anterior C 2-C 3
locking plate fusion and C 2 bilateral dorsal transpedicular screw fixation. No operative
morbidity resulted from this procedure, and stable bony fusion was achieved with minimal
restriction of head mobility and with minor residual complaints. This case illustrates
the variable biomechanical response of the upper cervical spine to trauma and the
advantages of a non-standard surgical approach for internal fixation of the injured
cervical spine.
Axis Fracture - Cervical Spine - Hangman's Fracture
