Fractures of the cervical spine in patients afflicted with chronic ankylosing spondylitis present a very particular pattern. For a number of reasons the mortality is quite high, and unusually careful treatment is indicated. Over the past six years we have seen 4 cases of this condition. All of them displayed features differing significantly from fractures of the cervical spine not involved by ankylosing disease. Report of Cases Case I: J. B., a 53-year-old colored male, was admitted after a fall the night before, while intoxicated. He was said to have struck his brow, but no bruise could be seen and his only complaint was soreness of the neck. Radiographs showed advanced ankylosing spondylitis and a complete break irregularly across the posterior portion of C 5, extending forward through the C 5-6-interspace (Fig. 1). There was slight anterior slipping of the superior fragment. No neurologic defect was observed. A good history for spondylitis could not be obtained from the patient. He admitted only occasional pains and stiffness of the neck, which never bothered him greatly. Still, he was a rather dull person intellectually, and the radiographic evidence (which included lumbar spine changes and typical fusion of both sacroiliac joints) appeared conclusive. Treatment consisted in application of a cervical collar, and the patient was allowed home after a few days. One month following the injury his clinical condition was good and radiographs showed some progress of healing with no change in position at the fracture site. Case II: I. S., a 65-year-old white woman, fell down one flight of stairs two days before admission. She had no motor or sensory defect immediately after the fall, but did complain of pain in “the middle of her back.” After twenty-four hours she experienced gradual development of paralysis of all extremities. She gave a history of spinal arthritis for twenty-five to thirty years. On admission there was complete motor paralysis of the legs, but incomplete in the arms. Sensation was intact in the arms but lost below that level. Radiographs showed a fracture at the C 5–6 interspace, with some anterior displacement of the upper fragment. Stigmata of ankylosing spondylitis were present (Fig. 2). Treatment consisted of traction, and tracheostomy was performed to maintain a free airway. Despite all supportive measures the patient continued to decline; she died fourteen days after the accident. Autopsy confirmed gross damage to the spinal cord. Terminal pulmonary infection was assumed, but a complete autopsy was not performed. Case III: C. V., a 33-year-old white male, had had peripheral rheumatoid arthritis and spondylitis for some fifteen years before his final episode. For one year he had been completely bedridden, and for his last few months he had required hospitalization.
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Mar 1, 1978
Uberto Bortolotti + 4
Open Access