This type of injury has an extremely high death rate, with more than 6 per cent of patients not surviving, and many others suffering sudden paralysis or instant cardiac arrest due to spinal cord compression
Image for representational purpose only. Photo Courtesy: File pic
Kolkata doctors, who are a part of the neurosurgery team at Dhakuria recently successfully performed an exceptionally rare and life-saving operation on 56-year-old woman, who arrived at the hospital after a severe strangulation injury. It had caused multiple rib fractures and facial fractures along with a dangerous cervical spine injury known as a Type 2 odontoid fracture (a break in the upper part of the neck) that can instantly damage the spinal cord and is commonly referred to as a Hangman’s fracture.
This type of injury has an extremely high death rate, with more than 6 per cent of patients not surviving, and many others suffering sudden paralysis or instant cardiac arrest due to spinal cord compression.
Despite the seriousness of the situation, realising the urgency, the team led by Dr Nirup Datta, consultant – Neurosurgery and Dr Prakhar Gyanesh, consultant – Anaesthesiology, Manipal Hospital, Dhakuria decided that emergency stabilisation surgery offered the only real chance of saving the patient’s life and preventing paralysis.
The woman had no major internal injury to her abdomen, which allowed the medical team to quickly move toward surgical intervention. Imaging tests including X-ray and CT scan confirmed that the fracture was highly unstable, with two open breaks in the upper cervical vertebrae, making movement of the neck extremely dangerous. Because strangulation injuries usually cause immediate fatal damage to the spine due to the sudden backward bending and pulling forces on the neck, survival itself is rare. Even for patients who make it to the hospital alive, global studies show a high risk of death within one and three years, particularly among those aged fifty-five and above.
The doctors performed a highly specialised and relatively new technique known as Kotil’s Procedure, a method of fixing the broken neck bones from the back of the neck using screws on both sides of the first two cervical vertebrae (C1 and C2). On one side, they placed a C1–C2 transarticular screw (a screw that passes through the joint to hold the neck bones firmly in place), and on the other side they performed a posterior odontoid screw fixation (a screw placed from behind to secure the broken tip of the odontoid bone to the body of the C2 vertebra).
This combined approach gives very strong stability in a region that is extremely delicate because it surrounds the spinal cord, which controls movement and sensation in all four limbs. Kotil’s technique is used in only a few centres worldwide and so far, only about fifteen cases have been reported in medical literature, making this surgery in Dhakuria significant contribution at both the national and international levels.
The surgery demanded exceptional precision because even a slight error in screw placement can affect the spinal cord or nearby blood vessels, potentially leading to paralysis or stroke. After the operation, the patient recovered steadily with no neurological abnormalities, meaning she retained full ability to move all four limbs with normal strength. Due to her lung injury, the medical team had to perform a tracheotomy, a small opening made in the neck to help her breathe safely through a tube before she was discharged. Over a three-week hospital stay, she continued to improve without any new complications or nerve-related problems, an outcome that is exceptionally rare for this kind of injury.
Speaking about the case, Dr Dutta explained, “This was one of the most severe cases we encountered in our routine course of treatment. A Hangman-type fracture caused by strangulation often leads to immediate death. The fact that the patient survived long enough to reach us was extraordinary. Stabilising two unstable fractures in such a delicate region required absolute accuracy, and Kotil’s technique gave us the best chance to save her life without her experiencing any neurological trauma.”
Expressing her gratitude, the woman said, “I truly believe I got a second life. I came to the hospital in unbearable pain, not knowing if I would ever walk, move or be able to experience life again. Thanks to the doctors and their quick decisions, I am recovering without any nerve damage. I am extremely grateful to the entire team for giving me another chance at life.”
The woman returned home in stable condition, with her strength and mobility intact. Her survival and recovery represent not only a medical success but also a rare outcome in a type of injury that is often considered near fatal.
Subscribe today by clicking the link and stay updated with the latest news!" Click here!
