Abstract
Study design: Two cases of intraoperative, iatrogenic cervical spine fractures in patients with ankylosing spondylitis are reported. Objective: To describe the uncommon complication of iatrogenic cervical spine fractures occurring during spine surgery in patients with ankylosing spondylitis. Summary of background data: To our knowledge, this is the first report on this rare complication. Methods: A 39-year-old patient (1) with ankylosing spondylitis was operated on for cervical stenosis due to C1/2 anterolisthesis. Fifteen hours postoperatively, he developed acute quadriplegia. MRI revealed a fracture/dislocation of C6 on C7 and compression of the spinal cord at this level. Revision was performed with decompression and instrumentation from the occiput to T3. A 55-year-old patient (2) with ankylosing spondylitis and thoracic hyperkyphosis underwent a correction procedure consisting of costotransversectomy, anterior cage implantation at T8/9, and posterior instrumentation from T4 to L1. Halo traction was temporarily applied for correction. At the end of the operation, with the patient still under anesthesia, increased mobility of the cervical spine was noticed. Emergent MRI revealed a fracture of the anterior structures of C6/7. Posterior instrumentation from C5 to T1 was then performed. Results: Quadriplegia persisted in patient 1 until his death secondary to further complications. Patient 2 was mobilized without any neurologic deficits. The fracture healed in good alignment. Conclusions: Iatrogenic fractures of the cervical spine during surgery in ankylosing spondylitis patients are a rare but potentially severe complication. Early diagnosis and therapy are necessary before dislocation, cord compression, and subsequent neurologic impairment occur.
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References
Andersson O (1937) Röntgenbilder vid spondylarthritis ankylopoetica. Nord Med Tidskr 14:200
Capaci K, Hepguler S, Argin M, Tas I (2003) Bone mineral density in mild and advanced ankylosing spondylitis. Yonsei Med J 44(3):379–384
Cooper C, Carbone L, Michet CJ, Atkinson EJ, O‘Fallon WM, Melton LJ 3rd (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21(10):1877–1882
Donnelly S, Doyle DV, Denton A, Rolfe I, McCloskey EV, Spector TD (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53(2):117–121
Dos Santos FP, Constantin A, Laroche M, Destombes F, Bernard J, Mazieres B, Cantagrel A (2001) Whole body and regional bone mineral density in ankylosing spondylitis. J Rheumatol 28(3):547–549
El Maghraoui A, Borderie D, Cherruau B, Edouard R, Dougados M, Roux C (1999) Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 26(10):2205–2209
Finkelstein JA, Chapman JR, Mirza S (1999) Occult vertebral fractures in ankylosing spondylitis. Spinal Cord 37(6):444–447
Hitchon PW, From AM, Brenton MD, Glaser JA, Torner JC (2002) Fractures of the thoracolumbar spine complicating ankylosing spondylitis. J Neurosurg 97(Suppl. 2):218–222
Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford) 39(1):85–89
Mullaji AB, Upadhyay SS, Ho EK (1994) Bone mineral density in ankylosing spondylitis. DEXA comparison of control subjects with mild and advanced cases. J Bone Joint Surg Br 76(4):660–665
Olerud C, Frost A, Bring J (1996) Spinal fractures in patients with ankylosing spondylitis. Eur Spine J 5(1):51–55
Rinsky LA, Reynolds GG, Jameson RM, Hamilton RD (1976) A cervical spinal cord injury following chiropractic manipulation. Paraplegia 13(4):223–227
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Ruf, M., Rehm, S., Poeckler-Schoeniger, C. et al. Iatrogenic fractures in ankylosing spondylitis—a report of two cases. Eur Spine J 15, 100–104 (2006). https://doi.org/10.1007/s00586-005-0973-8
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DOI: https://doi.org/10.1007/s00586-005-0973-8