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Case Report
Deformity correction in the setting of acute cervical spine trauma in a patient with ankylosing spondylitis: A case report
1 Physician, Department of Orthopaedics and Rehabilitation, Howard University Hospital, Washington, DC, USA
2 Medical Student, Howard University College of Medicine, Howard University Hospital, Washington, DC, USA
3 Chief, Department of Neurosurgery, Howard University Hospital, Washington, DC, USA
Address correspondence to:
Damirez Fossett
MD, FAANS, FACS, 2041 Georgia Ave NW, Washington, DC,
USA
Message to Corresponding Author
Article ID: 100110Z12EO2022
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Osadebey EN, Goins K, Harper CN, Fossett D. Deformity correction in the setting of acute cervical spine trauma in a patient with ankylosing spondylitis: A case report. J Case Rep Images Surg 2022;8(2):31–37.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.
Keywords: Ankylosing spondylitis, Cervical fracture, Deformity correction
SUPPORTING INFORMATION
Author Contributions
Emmanuel N Osadebey - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Karnesha Goins - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Cierra N Harper - Acquisition of data, Drafting the article, Final approval of the version to be published
Damirez Fossett - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Emmanuel N Osadebey et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
