Search PubMed⌕ Search

Biomedical subjects

C A Dickman

Publications and source records attributed to C A Dickman.

At least 19 recordsLinked to original sources
PubMed1999

Bilateral sagittal split mandibular osteotomies as an adjunct to the transoral approach to the anterior craniovertebral junction. Technical note.

Transoral approaches are used to expose the craniovertebral junction anteriorly. In patients in whom there is limited mandibular excursion, the placement of retractors and/or surgical instruments is difficult, and midline "stairstep split mandibulotomy" has been advocated as an adjunctive procedure. Although effective, this approach requires external splitting of the lip as well as median glossotomy or a lateral mucosal incision. The purpose of this study was to show that bilateral sagittal split mandibular osteotomies (BSSMOs), which are used in orthognathic surgery, represent a safer and more effective alternative to the stairstep split mandibulotomy when performed as an adjunct to the transoral approach because all incisions are intraoral and the plane of retraction is rostrocaudal instead of lateral. Hospital records and radiographic files of four patients who underwent BSSMO/transoral approach for odontoidectomy between 1994 and 1997 were reviewed retrospectively. There were three women and one boy (mean age 37.8 years, range 11-68 years). Predisposing conditions included rheumatoid arthritis (two patients), Klippel-Feil syndrome (one patient), and congenital occipitocervical instability (one patient). Jaw mobility was limited in all patients. In addition, one patient had macroglossia, another micrognathia, and another retrognathia. The BSSMO provided excellent exposure for resection of the odontoid process, as verified on follow-up magnetic resonance imaging or computerized tomography studies obtained in all patients. All mandibles were rigidly fixed by placing anterior mandibular border titanium plates and unicortical screws, and there was no incidence of nonunion or of lingual or inferior alveolar nerve injuries. The mean follow-up period was 26 months. The BSSMO is an excellent, less invasive adjunct to the transoral approach in patients with limited jaw mobility.

Adolescent↗
PubMed1998

The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis.

STUDY DESIGN: A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients. OBJECTIVES: To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury. SUMMARY OF BACKGROUND DATA: The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients. METHODS: Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively. RESULTS: The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group. CONCLUSION: Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.

Adult↗
PubMed1998

Biomechanical comparison of C1-C2 posterior fixations. Cable, graft, and screw combinations.

STUDY DESIGN: Four combinations of cable-graft-screw fixation at C1-C2 were compared biomechanically in vitro using nondestructive flexibility testing. Each specimen was instrumented successively using each fixation combination. OBJECTIVES: To determine the relative amounts of movement at C1-C2 after instrumentation with various combinations of one or two transarticular screws and a posterior cable-secured graft. Also to determine the role of each component of the construct in resisting different types of loading. SUMMARY OF BACKGROUND DATA: Spinal stiffness increases after instrumentation with two transarticular screws plus a posterior wire-graft compared with a wire-graft alone. Other C1-C2 cable-graft-screw combinations have not been tested. METHODS: Eight human cadaveric occiput-C3 specimens were loaded nondestructively with pure moments, and nonconstrained motion at C1-C2 was measured. The instrumented states tested were a C1-C2 interposition graft attached with multistranded cable; a cable-graft plus one transarticular screw; two transarticular screws alone; and a cable-graft plus two transarticular screws. RESULTS: The transarticular screws prevented lateral bending and axial rotation better than the posterior cable-graft. The cable-graft prevented flexion and extension better than the screws. Increasing the number of fixation points often significantly decreased the rotation and translation (paired t test; P < 0.05). Axes of rotation shifted from their normal location toward the hardware. CONCLUSIONS: It is mechanically advantageous to include as many fixation points as possible when atlantoaxial instability is treated surgically.

Adult↗
PubMed1998

The radiographic and imaging characteristics of porous tantalum implants within the human cervical spine.

STUDY DESIGN: Seven cadaveric cervical spines were implanted with a porous tantalum spacer and a titanium alloy spacer, and their radiographic and imaging characteristics were evaluated. OBJECTIVE: To determine the radiographic characteristics of porous tantalum and titanium implants used as spacers in the cervical spine. SUMMARY OF BACKGROUND DATA: Anterior decompressive surgery of the disc space or the vertebral body creates a defect that frequently is repaired with autologous bone grafts to promote spinal fusion. Donor site morbidity, insufficient donor material, and additional surgical time have spurred the development of biomaterials to replace or supplement existing spinal reconstruction techniques. Although the promotion of a solid bony fusion is critical, the implanted biomaterial should be compatible with modern imaging techniques, should allow visualization of the spinal canal and neural foramina, and should permit radiographic assessment of bony ingrowth. METHODS: Cadaveric spines containing the implants were imaged with plain radiography, computerized tomography, and magnetic resonance imaging. The image distortion produced by the implants was determined qualitatively and quantitatively. RESULTS: The tantalum and titanium spacers were opaque on plain radiographic films. On computed tomographic scans, more streak artifact was associated with the tantalum implants than with the titanium. On magnetic resonance imaging, the porous tantalum implant demonstrated less artifact than did the titanium spacer on T1- and T2-weighted spin echo and on T2*-weighted gradient-echo magnetic resonance images. Overall, the tantalum implant produced less artifact on magnetic resonance imaging than did the titanium spacer and therefore allowed for better visualization of the surrounding bony and neural structures. CONCLUSION: The material properties of titanium and porous tantalum cervical interbody implants contribute to their differential appearance in different imaging methods. The titanium implant appears to image best with computed tomography, whereas the porous tantalum implant produces less artifact than does the titanium implant on several magnetic resonance imaging sequences.

Artifacts↗
PubMed1998

Herniated thoracic discs mimic cardiac disease: three case reports.

The authors report three patients (two males and one female) with herniated thoracic discs whose symptoms mimicked cardiac disease (severe intense stabbing pain beginning in the back and radiating to the lateral wall of the chest). They were evaluated for cardiac disease and angina, but the workup of the heart was negative. Magnetic resonance imaging and computed tomography myelography revealed the herniated thoracic discs. All patients underwent video-assisted endoscopic thoracic discectomy and recovered completely.

Adult↗
PubMed1998

Thoracoscopic approaches to the thoracic spine.

Microsurgical approaches for the treatment of pathology located in the ventral thoracic spine using video-assisted thoracic surgery (VATS) allow neurosurgeons to access the disc spaces, vertebral bodies, paravertebral soft tissues, spinal cord, spinal nerves, and sympathetic chain with minimally invasive surgery. This has been associated with substantial clinical benefits including reduced postoperative pain, lower complication rates and shorter recovery times when compared with standard thoracotomy techniques. This article describes the experience at our institution with VATS for discectomy (20 cases), corpectomy and spinal reconstruction (8 cases), thoracic sympathectomy (3 cases), and nerve sheath tumor removal (1 case). The technique can be mastered but requires surgeons to learn the new psychomotor skills needed to perform endoscopic spine surgery. The learning curve is steep. Special training in instructional seminars, surgical skill laboratories, and clinical preceptorships is needed before this surgical approach can be used clinically to treat spinal pathology. VATS has significant advantages compared to standard thoracotomy, including reduced incisional pain and avoidance of the postthoracotomy pain syndrome. If intercostal neuralgia develops postoperatively, it is milder and usually transient compared to the pain associated with standard thoracotomy. Better cosmetic outcomes, earlier mobilization, and faster recovery are added benefits. The surgical techniques are relatively new for neurosurgeons and require dedicated practice to master them. Once the surgical skills are perfected, VATS is feasible for spinal pathology and can be performed safely and effectively.

Adolescent↗
PubMed1998

Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis.

OBJECTIVE: To assess the outcomes associated with C1-C2 transarticular screw fixation. METHODS: The clinical outcomes of 121 patients treated with posterior C1-C2 transarticular screws and wired posterior C1-C2 autologous bone struts were evaluated prospectively. Atlantoaxial instability was caused by rheumatoid arthritis in 48 patients, C1 or C2 fractures in 45, transverse ligament disruption in 11, os odontoideum in 9, tumors in 6, and infection in 2. RESULTS: Altogether, 226 screws were placed under lateral fluoroscopic guidance. Bilateral C1-C2 screws were placed in 105 patients; each of 16 patients had only one screw placed because of an anomalous vertebral artery (n = 13) or other pathological abnormality. Postoperatively, each patient underwent radiography and computed tomography to assess the position of the screw and healing. Most screws (221 screws, 98%) were positioned satisfactorily. Five screws were malpositioned (2%), but none were associated with clinical sequelae. Four malpositioned screws were reoperated on (one was repositioned, and three were removed). No patients had neurological complications, strokes, or transient ischemic attacks. Long-term follow-up (mean, 22 mo) of 114 patients demonstrated a 98% fusion rate. Two nonunions (2%) required occipitocervical fixation. In comparison, our C1-C2 fixations with wires and autograft (n = 74) had an 86% union rate. CONCLUSION: Rigidly fixating C1-C2 instability with transarticular screws was associated with a significantly higher fusion rate than that achieved using wired grafts alone. The risk of screw malpositioning and catastrophic vascular or neural injury is small and can be minimized by assessing the position of the foramen transversaria on preoperative computed tomographic scans and by using intraoperative fluoroscopy and frameless stereotaxy to guide the screw trajectory.

Adolescent↗
PubMed1998

Thoracoscopic microsurgical excision of a thoracic schwannoma. Case report.

A 6-cm-diameter schwannoma located at T-2 was resected completely by using transthoracic microsurgical endoscopy. The partially cystic tumor widened the neural foramen and extended into the apex of the right thoracic cavity but did not extend intradurally. The tumor was accessed by means of three 15-mm incisions made in the intercostal spaces. The operative blood loss was only 200 ml, and there were no complications. The patient was discharged on the 2nd postoperative day and returned to full activity 1 week after surgery. Thoracoscopy provides an excellent alternative to thoracotomy for peripheral thoracic nerve sheath tumors that originate within the neural foramen or more distally along the intercostal nerves within the thorax. An anterior approach is required for intrathoracic tumors but is not suited for intradural tumors. An open posterior or posterolateral approach to the thoracic spine is required for intradural tumors to allow the dura to be closed adequately.

Activities of Daily Living↗
PubMed1998

Thoracoscopic microsurgical excision of herniated thoracic discs.

OBJECT: The authors began using thoracoscopy to treat pathological conditions of the spine in 1992. In this study they delineate their clinical experience in which this procedure was used to resect herniated thoracic discs. METHODS: Fifty-five patients underwent thoracoscopy for the resection of herniated thoracic discs. Thirty-six patients presented with myelopathies and 19 with incapacitating thoracic radicular pain. Forty-three patients underwent a single-level, 11 a two-level, and one a three-level discectomy. The mean operative time for thoracoscopic microdiscectomy was 3 hours and 25 minutes (range 80-542 minutes) and the mean blood loss was 327 ml (range 124-1500 ml). Compared with thoracotomy, which was performed in 18 patients, thoracoscopy was associated with a mean of 1 hour less operative time and less than one-half of the blood loss, duration of chest tube drainage, usage of pain medication, and length of hospitalization. Compared with costotransversectomy, which was performed in 15 patients, thoracoscopy permitted more complete resection of calcified and midline thoracic discs because it provided a direct view of the entire anterior surface of the dura. Thoracotomy was associated with a significantly greater incidence of prolonged, disabling intercostal neuralgia compared with the mild transient episodes of intercostal neuralgia associated with thoracoscopy (50% compared with 16%). Thoracotomy also was associated with a significantly higher incidence of postoperative atelectasis and pulmonary dysfunction than thoracoscopy (33% compared with 7%). Clinical and neurological outcomes were excellent (mean follow-up period 15 months). Among the 36 myelopathic patients, 22 completely recovered neurologically; five improved functionally but had some residual myelopathic symptoms; and nine stabilized. Among the 19 patients with isolated thoracic radiculopathies, 15 recovered completely and four improved moderately; no patient had worsened radicular pain. CONCLUSIONS: Thoracoscopic microdiscectomy is a reliable surgical technique that can be performed safely with excellent clinical and neurological results.

Adult↗
PubMed1998

The spinal lax zone and neutral zone: measurement techniques and parameter comparisons.

The neutral zone (NZ) is a well-established parameter that describes the loose region of the spinal range of motion (ROM) where the spine moves easily with minimal applied force. The loose region is of interest clinically because in vitro studies show that with the onset of instability, this region increases before the ROM increases. The upper boundary of the NZ has been described as the displacement at which ligamentous resistance just begins. However, we hypothesized that a different parameter that we have named the lax zone (LZ) more accurately describes the region of ligamentous laxity. We hypothesized that the NZ is a smaller subset of the LZ that is governed by frictional properties at the joint. Methods for determining the spinal LZ experimentally are introduced. To demonstrate that the LZ is distinct from the NZ, both parameters were quantified in six normal cadaveric human C5-C6 specimens for three different preload magnitudes and three different preload directions. LZ variations with changing preload closely matched variations in the location of the load-deformation curve elbow, whereas NZ values followed specimen resting position instead, verifying parameter independence. Reproducibility and interspecimen variability values were approximately equivalent for both parameters. Compared in a separate data set, NZ and LZ were both more sensitive than ROM in response to cervical discectomy. With discectomy, the absolute change in LZ was larger and the percentage change in LZ was smaller than in NZ. The NZ may be a more appropriate measure when investigating the biomechanical effect of alterations to joint articulations and when the loading environment is well controlled. The LZ may be a more appropriate measure when investigating the effect of ligament/disc alterations and when the loading environment cannot be controlled. Future work is needed to compare the sensitivities of the LZ and NZ in detecting spinal instability onset for various injuries.

Cadaver↗
PubMed1997

Acute axis fractures. Analysis of management and outcome in 340 consecutive cases.

STUDY DESIGN: Retrospective review of acute axis fractures treated at a tertiary referral center. OBJECTIVE: To determine the optimal treatment of axis fractures based on 340 cases from a single institution. SUMMARY OF BACKGROUND DATA: Axis fractures account for almost 20% of acute cervical spine fractures. However, their management and the clinical criteria predictive of nonoperative failure remain unclear. METHODS: Admission imaging studies and clinical variables were obtained for 340 consecutive axis fracture patients. Fractures were classified as as odontoid Type I, II, or III with dena displacement on admission roentgenograms; hangman's fractures of Francis grade and Effendi type; and miscellaneous fractures. Treatment methods were documented, and outcomes were based on dynamic lateral roentgenograms, clinical examination, or telephone interviews at last follow-up. RESULTS: Follow-up data were available in 92% of cases. Type II odontoid fractures comprised 35% of all axis fractures, were the most difficult to treat, and had the highest nonunion rate (28.4%). Odontoid displacement of 6 mm or more was associated with Type II nonunion (chi-square = 33.74, P < 0.0001). Patients underwent surgical fusion if fracture alignment could not be maintained by an external orthosis, or if they had odontoid fractures with transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm, or hangman's fractures of severe Francis grade or Effendi type. CONCLUSIONS: Type II odontoid fractures have the highest nonunion rate and were associated with dens displacement of 6 mm or greater. Early surgical fusion is recommended for acute fracture instability despite external immobilization, transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm on admission, or severe Francis grade or Effendi-type hangman's fractures. Otherwise, nonoperative management is sufficient.

Adolescent↗
PubMed1997

Comparative mechanical properties of spinal cable and wire fixation systems.

STUDY DESIGN: Surgical spinal cable and wire fixation systems were tested mechanically using standardized methodologies. OBJECTIVES: To compare the relative mechanical properties and biomechanical performances of the different commercially available spinal wire and cable fixation devices, and to provide information that will help in selecting different cables for different clinical applications. SUMMARY OF BACKGROUND DATA: Spinal cables have become extensively used for spinal fixation; however, there are few published accounts delineating their mechanical properties. No reports have compared the relative properties of different cable systems. METHODS: Nine spinal cable and wire fixation systems were mechanically tested to compare their static tensile strength, stiffness, fatigue strength, creep, conformance, and abrasion properties. Titanium and stainless steel Codman cable, Danek cable, and AcroMed cable, polyethylene Smith & Nephew cable, and 20- and 22-gauge stainless steel monofilament Ethicon wire were tested using identical methodologies. The cable or wire was connected into loops with methods that simulated in vivo clinical applications. RESULTS: Under static tensile testing, titanium cables had 70% to 90% of the ultimate tensile strength of the comparable steel cables; the different cables were 100% to 600% stronger than monofilament wire; the ultimate strength of the polyethylene cable was similar to that of the strongest available steel cable. Fatigue testing delineated important differences among the different materials. For a given manufacturer, titanium cables were always more susceptible to fatigue than stainless steel cables of comparable diameter. Polyethylene cable withstood cyclical loading without breaking better than all of the metal cables and wires. The mechanisms of failure differed substantially among materials and types of tests. Polyethylene cables exhibited significant stretching or "creep" at loads that were much lower than the static failure loads. In contrast, no wire cable demonstrated creep. Monofilament wires demonstrated little creep. Polyethylene cables failed by elongating and loosening; wire cables failed by breaking. Monofilament wire and cables conformed least to a solid surface; polyethylene cable conformed the most and flattened out against solid surfaces. Abrasion properties depended on the surface characteristics of the implants. Polyethylene cable was abraded by (and eventually failed by wearing against) the simulated bone, a result that did not occur with any metal cables or wires. The steel and titanium cables and the monofilament wires all had an ability to abrade through simulated bone. CONCLUSIONS: Titanium, steel, and polyethylene cable systems all behave substantially differently mechanically compared with monofilament wire. The relative advantages and disadvantages of each particular products should be considered when selecting an implant for a specific clinical use.

Bone Wires↗
PubMed1997

Biomechanical effects of transthoracic microdiscectomy.

STUDY DESIGN: Nondestructive flexibility testing was performed to quantify biomechanical parameters of human cadaveric thoracic spines before and after microdiscectomy. OBJECTIVES: To assess the biomechanical differences between the normal thoracic spine and the thoracic spine after microdiscectomy and to determine whether microdiscectomy results in spinal instability. SUMMARY OF BACKGROUND DATA: Previous studies have investigated thoracic disc properties and the biomechanical effects of thoracic ligament or bone trauma. No studies were found assessing the effects of thoracic discectomy. METHODS: Eight motion segments (T4-T5 to T11-T12) from five human cadaveric thoracic spines were studied before and after microdiscectomy. Three-dimensional motion was recorded in response to nondestructive, nonconstraining pure moments. Parameters measured included the neutral zone, elastic zone, range of motion, rotational flexibility, and instantaneous axis of rotation. RESULTS: The neutral zone, elastic zone, and range of motion increased a small but significant (average P = 0.02 for range-of-motion increase) amount in all directions after thoracic microdiscectomy (mean bilateral range of motion increase, 2.1 degrees; range, 0.5-4.2 degrees). Flexibility increased slightly during lateral bending and flexion. The instantaneous axis of rotation location usually did not change, but sometimes shifted slightly away from the discectomy site after microdiscectomy. CONCLUSIONS: Thoracic microdiscectomy had small effects on the immediate mechanics and kinematics of the thoracic spine and did not overtly destabilize the motion segments.

Adult↗
PubMed1997

Construction of local vertebral coordinate systems using a digitizing probe. Technical note.

STUDY DESIGN: When studying three-dimensional motion of multiple-vertebra spine segments in vitro, it is often desirable to report the kinematics at the individual vertebral levels in terms of each level's local coordinates systems. A novel technique is described for constructing local vertebral coordinate axes using a standard digitizing probe. OBJECTIVES: To describe a technique that was developed to allow researchers to relate vertebral landmarks to optical markers and to set the local coordinate axes of several vertebrae accurately through a short, simple procedure performed only once at the beginning of a spine testing experiment. SUMMARY OF BACKGROUND DATA: Other researchers have used radiographs and careful marker placement for establishing the coordinate systems of vertebrae and the relationships of anatomic landmarks to optical markers. The authors found no publications giving details of how vertebral coordinate systems are established from anatomic landmarks. METHODS: A digitizing probe is used to identify vertebral landmarks and to relate these landmarks to optical markers attached to the vertebrae. An algorithm is described whereby vertebral coordinate axes are constructed from the landmarks. RESULTS: The method described has been implemented successfully in a computerized in vitro spinal flexibility testing system that plots each individual motion segment's load-deformation curves in real time during experimentation. The proposed technique is less labor intensive and error prone than the earlier methods because landmarks are identified directly. CONCLUSIONS: The described technique quickly, easily, and accurately relates anatomic landmarks to optical markers and constructs local coordinate axes, two steps that are necessary before monitoring the kinematics of individual motion segments during multilevel spine testing.

Algorithms↗
PubMed1997

Comparative pull-out strength of tapped and untapped pilot holes for bicortical anterior cervical screws.

STUDY DESIGN: This biomechanical study analyzed the axial pull-out strength of tapped versus untapped pilot holes for bicortical screws in the anterior cervical spine. OBJECTIVE: To determine which pilot hole preparation method was mechanically better. SUMMARY OF BACKGROUND DATA: Tapping pilot holes in the lumbar spine was previously shown significantly to reduce pull-out strength of pedicle screws. No study was found investigating the effect of tapping on pilot holes for anterior cervical bicortical screws. METHODS: Twenty-five unembalmed human cadaveric cervical vertebrae (C3-C7) were tested. Two identical pilot holes were drilled into each vertebra: one pilot hole was tapped, and the control pilot hole was not tapped. A fully threaded cortical bone screw was inserted into each pilot hole. Screw pull-out strength was determined using a servocontrolled hydraulic materials testing system and an axial load cell. Force-deformation and failure curves were obtained. RESULTS: There were no statistically significant differences between the axial pull-out strength of tapped and untapped pilot holes at any vertebral level. Mean force to-failure was 386 +/- 42 N in the untapped pilot holes and 397 +/- 48 N in the tapped pilot holes. CONCLUSIONS: Tapping a pilot hole for bicortical screws of the anterior cervical spine neither weakens nor strengthens the axial pull-out strength of fully threaded cortical bone screws. Tapping may be unnecessary; however, it may be desirable in patients with dense bone to cut the thread profile into the bone or if the screws have dull tips and threads.

Adult↗
PubMed1997

Management of postoperative infections after spinal instrumentation.

The authors retrospectively reviewed 452 consecutively treated patients who underwent a spinal instrumentation procedure at a single institution to establish which patients and which surgical approaches might be associated with an increased risk of developing deep wound infections and to determine the efficacy with which the institution's current treatment strategy eradicates these infections. Wound infections occurred in 17 patients (10 men and seven women) with spinal instrumentation (incidence 3.8%). All infections occurred after posterior spinal instrumentation procedures (7.2%); there were no infections after anterior instrumentation procedures regardless of the level. Each patient was assigned an infection risk factor (RF) score depending on the number of RFs identified in an individual patient preoperatively. The mean RF score of patients who developed infections was 2.18, whereas the mean RF score for a procedure-matched, infection-free control group was 0.71. The mean number of days from surgery to clinical presentation was 27.6 days (range 4-120 days), and the mean increase in hospitalization time for the subset of patients who developed infections was 16.6 days. The most common organism isolated from wound cultures was Staphylococcus aureus (nine of 17 cases). Of the 17 patients, five had infections involving multiple organisms. All patients were infection free at a minimum of 8 months follow-up review. The current treatment regimen advocated at this institution consists of operative debridement of the infected wound, a course of intravenous followed by oral antibiotic medications, insertion of an antibiotic-containing irrigation-suction system for a mean of 5 days, and maintenance of the instrumentation system within the infected wound.

Adult↗
PubMed1997

Completely dislocated hangman's fracture with a locked C2-3 facet. Case report.

The authors report a rare case of a hangman's fracture involving complete dislocation of C-2 onto C-3, accompanied by a C2-3 locked facet and asymptomatic bilateral vertebral artery injuries. The patient, a 25-year-old man who sustained a neck injury in an industrial accident, presented with a mild central spinal cord syndrome. His initial lateral cervical radiograph showed complete anterior dislocation of the C-2 body onto C-3, bilateral neural arch fractures, and a unilateral locked facet. The mechanism was likely flexion and compression. The grossly unstable spine and the locked facet were treated by posterior decompression, reduction, and C1-3 fixation. The patient recovered in several days and is without neurological deficit.

Adult↗