Posterior wiring with sublaminar polyester bands, titanium-peek fixation system for C2 fracture management: a 4-patient case series with a maximum of 18 months' follow-up

Abstract

Background: C2 fractures can be classified differently when dens, pedicles or body are injured. With regards to the best management of Type-II Anderson-D'Alonzo fractures, Hangman's fractures of pedicles and C2 body fractures are more debatable. However, vertebral pedicle and/or articular screw and dorsal wiring are the most common surgical posterior approaches opted for. Compared to the screw technique, dorsal wiring provides certain benefits such as a lower risk of vertebral artery injury, no need for navigation, less lateral dissection of the paraspinal muscles, shorter surgery time and lower medical costs.

Case description: Two patients with failed conservative treatment for Anderson-D'Alonzo Type-III fractures (Cases 1A and 1B), a patient suffering from a Type-II Hangman's fracture (Case 2) and a patient with failed conservative treatment for a C2 transversal body fracture (Case 3) underwent surgery at the Neurosurgery Division of the University Hospital of Modena (Italy) between July 2020 and September 2021. All patients were treated with posterior wiring with 5 mm Polyester bands, titanium-peek fixation system (Jazz-Lock system MediNext^®-Implanet) inserted through the C1 posterior arch and either the C2 or C3 laminae. A fracture diastasis reduction was observed ranging between 4.5 and 1 mm. No intraoperative and post-operative complications were encountered. The duration of the period of hospitalisation ranged between 5 and 12 days. All patients who had worked prior to the traumatic event were able to return to work 18 months following surgery.

Conclusions: In reducing C2 fractures, a sublaminar fixation with polyester bands and a titanium-peek fixation system can be proposed for fragile and elderly patients.

Keywords: C2 fractures; case series; posterior wiring; spine fracture consolidation.

Figure 1

Six-month follow-up CT scan. No evidence of fracture consolidation with increase in the retropulsion of the odontoid process has been disclosed at CT scan (diastasis 3 mm) and no evidence of bioactive cement. CT, computed tomography.

Figure 2

Twelve-month follow-up CT scan after surgery. Alignment of the dens, 2 mm of diastasis with pseudoarthrosis. CT, computed tomography.

Figure 3

Control CT scan after 11 months of conservative treatment. evolution in unstable pseudarthrosis and an increase of the diastasis (3 mm). CT, computed tomography.

Figure 4

Control CT scan 3 months after surgery. Reduction in the degree of fracture’s diastasis (1 mm) and pseudoarthrosis. CT, computed tomography.

Figure 5

First CT scan. C2 bipeduncular diastatic fracture (5 mm on the left and 4 mm on the right) irradiated to the laminae with anterolisthesis of C2 on C3 and increase of the interspinous distance of C1–C2 (Hangman’s C2 Type-II fracture). CT, computed tomography.

Figure 6

Six-month follow-up CT scan. Partial consolidation of the cervical fracture (diastasis 0.5 mm on the left and 0.5 mm on the right). CT, computed tomography.

Figure 7

Results of a follow-up CT scan performed 1 month after surgery. The cervical spine CT scan performed 1 month after the event showed an increase in fracture diastasis (2 mm). CT, computed tomography.

Figure 8

Results of a follow-up CT scan performed 3 months after surgery. Partial repairing phenomena (diastasis 1 mm). CT, computed tomography.

Figure 9

Titanium-peek fixation system (Jazz-Lock system MediNext^®-Implanet).

Figure 10

3D-view of the titanium-peek fixation system seen via the CT scan. CT, computed tomography.