We present a case of highly unstable Hangman’s fracture treated by a C2-3-4 posterior screwrod construction. Hangman’s fractures are often treated surgically with a C2-C3 anterior cervical discectomy, fusion and anterior plating. In our case we treated Hangman’s fracture by a C2-3-4 posterior screw-rod construction. The patient was operated in the sitting position and Mayfield head holder was used. Posterior C2 screw fixation combined with C3 and C4 lateral mass screw fixation, and rod construction was performed. Posterior stabilization with C2 pars interarticularis screw fixation combined with C3 facet screw fixation and rod construction is the treatment choice for Hangman’s fracture, especially associated with severe C2-3 instability.

Keywords: C2-3-4 posterior screw-rod construction, Hangman’s fracture, traumatic spondilolisthesis