Intraoperative myelography of traumatic spine injury in patients with ankylosing spondylitis. Technical note

Ankylosing spondylitis (AS) is an autoimmune inflammatory arthritis causing ossifications and rigidity of the spinal column. Patients with AS have a high incidence of spinal fractures, especially in the cervical spine, with a high rate of epidural hematomas. These have hazardous consequences, including neurological sequelae, and high morbidity and mortality. Diagnostics rely on CT and MRI scans, and therapy, usually open decompression and fixation, has to be done as soon as possible to enable recovery. However, in many cases, performing MRI scans is not possible for several reasons.

We present a case of an AS patient with paraparesis below T-8 after a fall who was not able to undergo MRI scan due to severe obesity, hyperkyphosis, and mechanical ventilation. CT scan did not demonstrate any fractures or hemorrhages in the thoracic spine and in addition a standard myelography could not be performed due to ossifications of ligaments. As an alternative, we performed an intra-operative myeolgraphy. Intra-operative installation of a lumbar drain made a myelography and post-myelographic CT scan feasible.

The scan revealed a contrast stop at T-10 and subsequently operative decompression and evacuation of the hematoma were performed.

We present a quick and safe technique, performed in the operation room (OR), to detect intra-spinal lesions in patients with contraindications for MRI, or for cases where MRI scans cannot be performed.