Cervical vertebral body fracture with ankylosing spondylitis treated with cervical pedicle screw: A fracture body overlapping reduction technique

Abstract

We describe a patient with ankylosing spondylitis (AS) with cervical spinal fracture treated with cervical pedicle screw placement (CPS) through a single posterior approach.A 43-year-old male patient with AS visited our emergency centre due to paralysis following a trauma. Coronal reconstructed cervical spine computed tomography (CT) scan showed a C5 oblique fracture, and the bilateral pedicles were separated superiorly and inferiorly. The sagittal reconstructed CT image revealed bamboo spine and C5 vertebrae body fracture. Hyperextension between the fractured segments of the C5 body was noted because the fracture gap was anteriorly open. Magnetic resonance imaging (MRI) showed cord compression and injury at the C4–5 level.CPS was performed at the C3–6 levels. Because the left and right pedicles were displaced superiorly and inferiorly, dual compressions between the left C5 and left C6 pedicle screws and between the right C5 and right C4 pedicle screws were performed. Decompression at the C4 and C5 levels was performed after identifying good alignment. This posterior fusion surgery was performed for two hours. After surgery, the radiograph showed complete reduction and fracture gap apposition. The patient was rehabilitated, and his muscle strength improved. Postoperative CT and X-rays revealed complete fracture site fusion and correct CPS position.Considering increased morbidity of long-level or -duration surgery, our fracture body overlapping technique using CPS and posterior only approach seems to be a possible and good surgical method in traumatic cervical fracture with AS.