Unstable Hangman Fracture Complicated by Vertebral-Venous Fistula: Surgical Considerations and Review of Literature.

Abstract

Hangman fracture or traumatic spondylolisthesis of the axis associated with a traumatic vertebral venous fistula (VVF) is a rare entity and sparsely reported in literature. Standard recommendations for management of such rare and complex scenarios are not available and hence the strategy has to be individualized on a case-by-case basis. We report a 70-year-old man having an unstable hangman fracture with VVF. Both pathologies were simultaneously managed uniquely. The VVF was managed by endovascular occlusion. The fracture was managed by anterior fusion alone as posterior fusion was deemed riskier in the aftermath of a recently occluded VVF. The patient had good neck function and bony fusion at 1-year follow-up. This case report emphasizes the need for timely recognition and management of a VVF, which can rarely coexist with hangman fracture, and discusses the interesting surgical paradigms in the management. We also present a review of literature.