C1-C3 Lateral Mass Screw-Rod Fixation and Fusion for C2 Pathologies and Hangman's Fractures

STUDY DESIGN: Retrospective clinical study. PURPOSE: We report our experience of eight patients treated with C1-C3 lateral mass rod-screw stabilization and fusion in the treatment of Hangman's fracture and other axis pathologies. OVERVIEW OF LITERATURE: Different surgical approaches, both anterior and posterior, have been described for treating Hangman's fracture and other pathologies where surgery is indicated. METHODS: All patients who underwent surgical treatment for Hangman's fracture and axial pathology where C1-C3 lateral mass screw-rod stabilization and fusion done, following reduction of the fracture or removal of the pathology were included in this series. The recorded patient management data was retrospectively studied. RESULTS: There were 8 cases in total. All were male, with an average age of 40.75 years. Hangman's fracture occurred in 6 cases (75%), one with metastatic squamous cell carcinoma and the remaining with plasmocytoma. Among the Hangman's fractures 4 (66.66%) had no neuro-deficit. Reduction and bilateral C1-C3 lateral mass screw and rod fixation with posterior fusion by bone graft was performed in all cases. In 2 cases, a C2 body tumor was removed transorally. All patients with neuro-deficit fully recovered, except one who expired in the early post-operative period. Rest of all patients were leading a normal life till last follow up. CONCLUSIONS: Although the number of cases was very small with a relatively short follow up period, C1 and C3 lateral mass screw-rod fixation followed by fusion showed promise as an effective and biomechanically sound way for the treatment of properly selected Hangman's fracture cases, and may also be suitable in other axial pathologies.

Papez circuit: An anatomical study by cadaveric dissection

This study was done to completely the Papez circuit by cadaveric dissection and it's relation to ventricles and other related anatomical structures. Eight formalin fixed cerebral hemispheres were microscopically dissected for Papez circuit. Klingler's technique of fibre dissection was adopted. The circuit was dissected from medial and superior-lateral cerebral surfaces. Bilateral hemispheric dissection was done simultaneously in intact brain from superior-lateral surface in two brains [4 hemispheres]. During and after dissection it's relation with lateral ventricles and other related structures were studied. Papez circuit was demonstrated by total dissection. Fibres leave the hippocampal formation and proceed through the fomix; most of these fibres have been shown to terminate in the mammillary nuclei of the hypothalamus. From here, the mammillothalamic tract ascends to the anterior group of thalamic nuclei. This group of nuclei projects to the cingulated gyrus through the anterior limb of internal capsule to anterior cingulated gyrus. From the cingulated gyrus there is an association bundle; the cingulum, which connects the cingulated gyrus with the parahippocampal gyrus part of the limbic lobe. The parahippocampal gyrus projects to the hippocampal formation and circuit is completed. Relation of different parts of the circuit with surrounding structures were also clearly seen. Knowledge of the microsurgical anatomy of the Papez circuit is not only important for understanding memory mechanism and other limbic functions but also very important in management of lateral and third ventricular lesions, in transcallosal, transventricular, supraseller and temporal lobe surgery, and for psycho-neurosurgery