J Korean Soc Spine Surg.  2017 Dec;24(4):246-251. 10.4184/jkss.2017.24.4.246.

Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur: A Case Report

• You JW
• Kang SW
• Sohn HM

• KMID: 2408194
• DOI: http://doi.org/10.4184/jkss.2017.24.4.246

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To report a case of paraplegia in a patient with thoracic kyphosis after osteosynthesis for a fracture of the femur. SUMMARY OF LITERATURE REVIEW: There are few reports about cases of paraplegia after low extremity fracture surgery in patients with thoracic kyphosis with ankylosing spondylitis.
MATERIALS AND METHODS
An 86-year-old female patient presented with right hip pain. She had undergone surgery for an intertrochanteric fracture of the femur in the supine position under general anesthesia. Immediately after surgery, she showed paraplegia. Postoperative thoracolumbar spine images revealed a fracture through the disc at T12 and L1. However, she did not complain of back pain or any neurologic deficits before surgery.
RESULTS
Although the patient underwent emergent posterior decompression and fusion surgery, her neurologic compromise did not improve during 1 year of follow-up.
CONCLUSIONS
It is necessary to check preoperative spine radiographs before surgery in elderly patients who have a kyphotic deformity and lower extremity fractures. Surgeons should consider changing the position of the patient and the type of anesthesia used during surgery when spine stability is in doubt.

Keyword

Ankylosing spondylitis; Spine fracture; Lower extremity fracture; Paraplegia; Thoracic kyphosis

MeSH Terms

Aged
Aged, 80 and over
Anesthesia
Anesthesia, General
Back Pain
Congenital Abnormalities
Decompression
Extremities
Female
Femur*
Follow-Up Studies
Hip
Humans
Kyphosis
Lower Extremity
Neurologic Manifestations
Paraplegia*
Spine*
Spondylitis, Ankylosing*
Supine Position
Surgeons

Figure

• 

  Fig. 1. An intertrochanteric fracture of the right femur (Boyd-Griffin type II, Evans unstable) is observed on a preoperative pelvic radiograph (A). Postoperative pelvic radiographs show that the fracture was fixed by a cephalomedullary nail (B).

• 

  Fig. 2. Lumbar spine radiography before hip surgery showed bamboo spine with extensive fusion across the entire spine (A). On the lateral view, there was a gap between T12 and L1 (B). Thoracolumbar lateral spine radiographs after hip surgery show a more displaced thoracolumbar fracture and deviated spine alignment (C).

• 

  Fig. 3. A 3-dimensional reconstructed computed tomography scan after hip surgery revealed a wide range of upper and lower vertebral fusion and worsening of the thoracolumbar fracture in the anteroposterior view (A) and lateral view (B).

• 

  Fig. 4. Magnetic resonance imaging after hip surgery showed a discontinuity of the spinal canal due to fracture and dislocation of T12-L1 (A) and severe canal compromise (B).

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  Fig. 5. Thoracolumbar spine radiographs after the emergent spine operation showed posterior instrumentation and posterolateral fusion of T11-L4 and restoration of the spine alignment in anteroposterior (A) and lateral views (B).

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