Cervical Spine Fractures in Ankylosing Spondylitis : A case Report

Chung, Jae Yoon; Heo, Jung Pil; Seo, Hyong Yeon

Abstract

The patient with ankylosing spondylitis is easily apt to be fractured in spine regions, even by minor trauma due to severe limitation of spinal motion and progressive osteoporosis. In those patients, accurate reduction and rigid internal or external immobilization and postoperative early mobilization is very important to treat or prevent the spinal cord injury. Untill now halo-vest immobilization or posterior fusion is widely accepted method of treatment and there was no report about anterior plate fixation. Authors fused the patient anterorily with tricortical iliac graft and plate with compression mechanism to get early solid bony union, to increase the immediate rigid stability, to correct the deformity and to mobilize the patient early as possible. We have experienced a 54-year-old male patient with ankylosing spondylitis complicating traumatic fracture of the cervical spine at C6-7 and follow up study of 9 years was possible. The patient was injured by minor pedestrian motor vehicle accident. Pre-injury activity was normal, and neurological status was Frankel grade D just after trauma however, it was aggrevated to Frankel grade C paraplegia during position change before operation. The patient was anesthesized with aid of the tracheostomy. Anterior plate fixation was performed with tricortical iliac suut bone graft and plate. And then early mobilization was encouraged with SOMI brace. Neurological status was improved and there was no peri- and post-operative complications. Systemic complications was not occured also. Re-displacement at fracture site with minimal screw loosening during follow up period was observed however, solid bony union was obtained at post-operative 3 months without further displacement or loosening. We report this case with review of literatures for good clinical result of anterior fusion with plate during long term follow up period of 9 years.