Fractures of the neural arch of the axis. A report of twenty-nine cases.

Twenty-nine patients with fractures of the neural arch of the axis (hangman's fracture) were followed for an average of six years. Hyperextension and longitudinal compression were probably the forces most frequently causing this injury. Serious neurological damage was uncommon; none of these patients had any neural deficit at follow-up. In addition to the six patients in this series who were treated by surgical fusion, the remaining twenty-three patients, treated by traction and immobilization, all regained a stable cervical spine. Because healing of the fracture of the neural arch or spontaneous interbody fusion between the axis and the third cervical vertebra invariably occurs, surgical treatment of this injury is seldom if ever necessary.