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.