Deformity correction in the setting of acute cervical spine trauma in a patient with ankylosing spondylitis: A case report

Abstract

Introduction: Ankylosing spondylitis (AS) is an autoimmune spondyloarthropathy marked by symptomatic alterations in skeletal anatomy and biomechanics. Ankylosis from the ossification of ligamentous structures and adjacent joints transforms the spine from flexible to rigid and brittle, easily susceptible to fracture. The pathophysiology of the condition is also notable for a progressive debilitating cervical kyphosis known as “chin-on-chest.” Ultimately, the combination of a brittle, rigid, spine can permit trivial trauma to cause catastrophic injury, and in some instances, mortality. We discuss the multi-disciplinary approach, management concerns, and deformity correction in the setting of traumatic cervical spine fracture in a patient with ankylosing spondylitis. Case Report: A 71-year-old man with ankylosing spondylitis presented to Howard University Hospital in a delayed fashion after a ground level fall at home. Neurological examination revealed loss of all motor and sensory function below the C4 level and an absence of rectal tone. Advanced imaging discovered a fracture-dislocation at the C4-5 level producing a severe hyper-lordotic angulation deformity. The profound fracture characteristics and displacement caused spinal cord compression posteriorly and tracheoesophageal stenosis anteriorly. The patient was treated operatively in a staged dual approach fashion correcting his pathologic deformity in consideration of long-term care needs. Postoperatively, upon completion of his final neurosurgical procedure, his sensory exam notable for return of sensation from C5-T1 and he was also able to appreciate and interact with the environment around him as his viewpoint was no longer rigidly caudally oriented. The patient was discharged from the hospital to a long-term care facility in stable condition. Conclusion: Cervical fractures sustained after minor trauma in a patient with ankylosing spondylitis are not uncommon. However, surgical intervention with concomitant deformity correction in the traumatic setting is substantial undertaking with a paucity of literature on such surgical techniques. Surgical deformity correction in the acute trauma setting allowed for optimization of anticipated medical care initiatives and successfully provided newfound visual awareness of his environment, improving upon his ability to interact with the world.