Simultaneous Cervical and Lumbar Vertebral Fracture-Dislocation in an Ankylosing Spondylitis Patient: A Case Report

TL;DR

A 59-year-old man with ankylosing spondylitis suffered simultaneous spinal fractures at C6 and L4 after trauma and was successfully treated with surgery.

Contribution

This case highlights the rare occurrence of simultaneous cervical and lumbar fractures in ankylosing spondylitis.

Findings

The patient had burst fractures at C6 and L4 with neurological deficits.

Surgical intervention included spinal instrumentation and decompression.

The patient showed no further neurological deterioration post-surgery.

Abstract

Fractures in ankylosing spondylitis (AS) patients tend to occur due to the absence of motion between vertebrae, poor bone quality, and a long lever arm that generates extension force. However, most patients have a history of at least minor trauma. Due to the spine's extreme instability in AS patients, even neurologically intact individuals can experience secondary neurological deterioration after unprotected transfers or manipulations.

We report a 59-year-old gentleman presenting late with acute neurological symptoms following a history of trauma. Fracture diagnosis in patients with ankylosing spondylitis (AS) poses a significant challenge due to vertebral fusion and altered spinal architecture. In this case, the patient sustained simultaneous burst fractures at C6 and L4 levels, with a significant neurological deficit. He underwent posterior spinal instrumentation and fusion (PSIF) from L1 to S2, PSIF from C3 to T2 with bone cement augmentation, and L4/L5 decompression laminectomy. Following a thorough investigation and appropriate surgical management, the patient was discharged home postoperatively without any further neurological deterioration.

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