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Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis
J Mountney1, A J Murphy, J L Fowler
1Department of Orthopaedic Surgery, Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 5DG, England, UK. jm84@jmountney.freeserve.co.uk
Summary
Cervical fractures in ankylosing spondylitis require initial neck stabilization in flexion. Early detection and management of cervical pseudoarthrosis are crucial to prevent myelopathy.
Area of Science:
- Orthopedics
- Neurosurgery
- Rheumatology
Background:
- Ankylosing spondylitis (AS) patients are at high risk for cervical spine fractures.
- Cervical fractures in AS can lead to severe complications, including pseudoarthrosis and myelopathy.
- Delayed diagnosis of cervical spine injuries in AS can result in poor outcomes.
Observation:
- A rare case of cervical pseudoarthrosis after a cervical spine fracture in an ankylosing spondylitis patient is presented.
- The pseudoarthrosis went undetected for months, leading to the development of myelopathic symptoms.
- Initial management involved stabilizing the neck in flexion using tongs.
Findings:
- The patient underwent sequential anterior and posterior fixation after initial flexion stabilization.
- Myelopathic symptoms resolved post-operatively.
- A good clinical outcome was achieved at 18 months follow-up.
Implications:
- Cervical fractures in ankylosing spondylitis necessitate careful evaluation and management.
- Initial neck stabilization in flexion is critical for these patients.
- Any increased spinal mobility after trauma in AS patients should be thoroughly investigated to rule out occult injuries like pseudoarthrosis.
