Pediatric Hangman Cervical Spine Fracture

  • Etiology: Hyperextension injury
  • Imaging: Fractures through bilateral pedicles of C2 resulting in avulsion of C2 body from arch with anterior translation of C2 on C3
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:

Radiology Cases of Hangman Cervical Spine Fracture

CT of C2 vertebral body / Hangman fracture
Axial CT without contrast of the cervical spine (top) shows a lucency extending through the left C2 facet and another lucency extending through the right transverse process and involving the right transverse foramen which raised concern for possible right vertebral artery injury which was ruled out on a subsequent CT angiogram of the neck. Sagittal 2D reconstructions from the left, center and right of the cervical spine shows lucencies through the left C2 facet (left image), right transverse process (right image) and anterior inferior aspect of the C2 vertebral body (center 2 images).
CT of fracture of C2 vertebral body / Hangman fracture
Axial CT without contrast of the cervical spine (upper left) shows lucencies through both pedicles of the C2 vertebral body. Midline sagittal 2D reconstruction (upper right) shows anterior dislocation of the C2 vertebral body on the C3 vertebral body. Left sagittal (lower left) and right sagittal 2D reconstructions (lower right) again show lucencies through the bilateral C2 pedicles and bilateral anterior perching of the C2 inferior facets on the C3 vertebral body.
Radiograph and CT of Hangman cervical spine fracture
Lateral radiograph of the cervical spine (left) shows a large amount of prevertebral soft tissue swelling. There are fractures through the bilateral pedicles of the C2 vertebral body resulting in anterior translation of the C2 vertebral body on the C3 vertebral body. Sagittal CT without contrast of the cervical spine through the left (above center) and right (above right) pedicles better demonstrates the fractures through them as does the axial CT through the C2 vertebral body (below right).