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Successful management of a cervical fracture in a patient with ankylosing spondylitis by a posterior approach.

Patni N, Shah A, Rangarajan V, Goel A - J Craniovertebr Junction Spine (2015 Oct-Dec)

Bottom Line: Patients with ankylosing spondylitis (AS) are at an increased risk of spinal fractures due to the altered spinal biomechanics.We report successful management of a C6-C7 vertebral fracture in a patient with AS.The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India.

ABSTRACT
Patients with ankylosing spondylitis (AS) are at an increased risk of spinal fractures due to the altered spinal biomechanics. Moreover, it is difficult to treat these fractures due to the combination of ankylosis and osteoporosis. We report successful management of a C6-C7 vertebral fracture in a patient with AS. The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months.

No MeSH data available.


Related in: MedlinePlus

(a) Delayed postoperative image showing healing of the fracture with good alignment and fusion. (b) Sagittal image of computed tomography scan through the facets showing the pedicular fixation
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Figure 2: (a) Delayed postoperative image showing healing of the fracture with good alignment and fusion. (b) Sagittal image of computed tomography scan through the facets showing the pedicular fixation

Mentions: A 50-year-old male came with a history of progressively worsening weakness of all four limbs after being hit by a wooden plank 1 month prior to presentation. When admitted, the patient had spastic quadriparesis of grade 2/5. There was hypoesthesia to all modalities of sensation below C7 level. The patient was unable to straighten his neck and was forced to keep it in a hanging flexed position due to severe pain. Three-dimensional computed tomography (CT) scan showed straightening of the entire spine (bamboo spine) with disruption of the anterior, middle, and posterior elements of the spine at C6-C7 level with listhesis of C6 over C7. The fracture line was seen to be passing through the upper portion of C7 vertebral body. There was a complete dysjunction of the vertebral column at C6-C7 level with the column moving as two separate fragments [Figure 1]. There was associated ossification of annulus, disc spaces, anterior and posterior longitudinal ligaments. There was severe osteoporosis of the vertebral bodies. Magnetic resonance imaging showed a fracture with listhesis of C6 over C7 with significant cord compression. A diagnosis of AS was made, and the patient was found to be HLA-B27 positive. Due to progressive neurological deficit and unstable nature of injury, we decided to intervene surgically. We opted for a posterior approach. The patient was placed in prone position under Gardner-Wells traction. A weight of 7 kg was applied. The cervico-dorsal spine was exposed. The C6 vertebra had dipped forward with fracture of the superior portion of the C7 vertebral body. Lateral mass screw and rod fixation was performed 3 levels above and below the listhesis. Intraoperative reduction was achieved by distraction. Bone graft was put over the instrumented spine to achieve fusion. The patient improved neurologically in the immediate postoperative period. Postoperative immobilization was given in the form of Philadelphia collar for 3 months. At a follow-up of 24 months, the patient's neurological recovery was sustained. He was able to ambulate independently and was able to perform all his routine activities. His neck pain had improved significantly. Postoperative CT images performed at this time showed maintenance of the reduction and fusion at the fracture site [Figure 2].


Successful management of a cervical fracture in a patient with ankylosing spondylitis by a posterior approach.

Patni N, Shah A, Rangarajan V, Goel A - J Craniovertebr Junction Spine (2015 Oct-Dec)

(a) Delayed postoperative image showing healing of the fracture with good alignment and fusion. (b) Sagittal image of computed tomography scan through the facets showing the pedicular fixation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660505&req=5

Figure 2: (a) Delayed postoperative image showing healing of the fracture with good alignment and fusion. (b) Sagittal image of computed tomography scan through the facets showing the pedicular fixation
Mentions: A 50-year-old male came with a history of progressively worsening weakness of all four limbs after being hit by a wooden plank 1 month prior to presentation. When admitted, the patient had spastic quadriparesis of grade 2/5. There was hypoesthesia to all modalities of sensation below C7 level. The patient was unable to straighten his neck and was forced to keep it in a hanging flexed position due to severe pain. Three-dimensional computed tomography (CT) scan showed straightening of the entire spine (bamboo spine) with disruption of the anterior, middle, and posterior elements of the spine at C6-C7 level with listhesis of C6 over C7. The fracture line was seen to be passing through the upper portion of C7 vertebral body. There was a complete dysjunction of the vertebral column at C6-C7 level with the column moving as two separate fragments [Figure 1]. There was associated ossification of annulus, disc spaces, anterior and posterior longitudinal ligaments. There was severe osteoporosis of the vertebral bodies. Magnetic resonance imaging showed a fracture with listhesis of C6 over C7 with significant cord compression. A diagnosis of AS was made, and the patient was found to be HLA-B27 positive. Due to progressive neurological deficit and unstable nature of injury, we decided to intervene surgically. We opted for a posterior approach. The patient was placed in prone position under Gardner-Wells traction. A weight of 7 kg was applied. The cervico-dorsal spine was exposed. The C6 vertebra had dipped forward with fracture of the superior portion of the C7 vertebral body. Lateral mass screw and rod fixation was performed 3 levels above and below the listhesis. Intraoperative reduction was achieved by distraction. Bone graft was put over the instrumented spine to achieve fusion. The patient improved neurologically in the immediate postoperative period. Postoperative immobilization was given in the form of Philadelphia collar for 3 months. At a follow-up of 24 months, the patient's neurological recovery was sustained. He was able to ambulate independently and was able to perform all his routine activities. His neck pain had improved significantly. Postoperative CT images performed at this time showed maintenance of the reduction and fusion at the fracture site [Figure 2].

Bottom Line: Patients with ankylosing spondylitis (AS) are at an increased risk of spinal fractures due to the altered spinal biomechanics.We report successful management of a C6-C7 vertebral fracture in a patient with AS.The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India.

ABSTRACT
Patients with ankylosing spondylitis (AS) are at an increased risk of spinal fractures due to the altered spinal biomechanics. Moreover, it is difficult to treat these fractures due to the combination of ankylosis and osteoporosis. We report successful management of a C6-C7 vertebral fracture in a patient with AS. The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months.

No MeSH data available.


Related in: MedlinePlus