Current Concepts in the Treatment of Traumatic C2 Vertebral Fracture : A Literature Review

The high cervical spine, which connects the brainstem to the spinal cord, is vital for both survival and everyday activities. This area is susceptible to injuries, with fractures of the C2 vertebra being a common occurrence among cervical fractures. This review focuses on two primary types of C2 vertebral fractures: odontoid fractures and Hangman’s fractures. Appropriate conservative treatment can lead to favorable outcomes for both types of fractures. The choice between anterior or posterior surgery should be based on careful consideration of the clinical situation, as no definitive evidence suggests one approach is superior to the other.

• 1
  Anterior screw fixation is generally preferred for type II odontoid fractures, while C1–2 fusion is recommended if nonunion is a concern.
• 2
  Stable type I and II Hangman's fractures can often be managed with external immobilization, whereas type IIA and III fractures usually require surgical stabilization.
• 3
  Surgical stabilization and fusion should be considered in cases of type 2 odontoid fractures involving C1–2 segment injury with an ADI of more than 5 mm, Hangman’s fracture with a C2–3 angulation of more than 11°, or failure of external immobilization.