C-2 arteriovenous fistula presenting as a pathologic hangman's fracture: Case report

Rajeev D. Sen, Carolina Gesteira Benjamin, Howard A. Riina, Donato Pacione

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The authors report on an 81-year-old woman with a pathologic hangman's fracture secondary to a complex arteriovenous fistula (AVF). The patient presented with severe, unremitting neck pain and was found to have fractures bilaterally through the pars interarticularis of C-2 with significant anterior subluxation of C-2 over C-3 along with widening of the left transverse foramen. Due to an abnormally appearing left vertebral artery (VA) on CT angiography, the patient underwent conventional angiography, which revealed a complex AVF stemming from the left VA at the level of C-2 with dilated posterior cervical veins and a large venous varix. Given the radiographic evidence of bone remodeling and the chronicity of the AVF, it is believed that the C-2 vertebra was weakened over time by the pulsatile and compressive force of the vascular malformation eventually leading to fracture with minimal stress. Coil embolization of the AVF was performed followed by surgical fixation of C-1 to C-4. This case highlights the importance of investigating an underlying disease process in patients who present with significant spinal fractures in the absence of trauma.

Original languageEnglish (US)
Pages (from-to)341-345
Number of pages5
JournalJournal of Neurosurgery: Spine
Issue number3
StatePublished - Mar 2017
Externally publishedYes


  • Arteriovenous fistula
  • Axis
  • Cervical spine
  • Hangman's fracture
  • Pathologic
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology


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