• Venugopal Sarath Chander, Ramachandran Govindasamy, Satish Rudrappa, and Swaroop Gopal.
• Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India; Department of Spine Surgery, Sakra World Hospital, Bellandur, Bangalore, India.
• World Neurosurg. 2021 Jan 1; 145: 409-415.

BackgroundHangman 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.MethodsWe 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.ConclusionThis 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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