Unexpected intercostal fusion of total thoracic fracture dislocation with ankylosing spondylitis

Fractures associated with ankylosing spondylitis (AS) are often challenging due to long-segment rigidity and severe displacement. Here, a 50-year-old male presented with a total T10 fracture/dislocation. After posterior fusion instrumentation was removed due to wound dehiscence, spontaneous intercostal fusion between the T10 and T11 ribs provided sufficient stability.

A 50-year-old male with AS after sustaining a severe T10 fracture/dislocation underwent an emergency posterior fusion. At surgery, the dural sac was ruptured and the spinal cord was completely transected. The thecal sac was tied off, and the patient underwent an instrumented T10-T11 fusion despite the inability to attain a significant reduction and the lack of adequate bone mass for the arthrodesis. Within 6 months, wound dehiscence due to a pressure sore resulted in implant exposure necessitating its removal. During that second surgery, there was prominent osseous bridging between the adjacent 10^th and 11^th ribs which appeared to adequately stabilize the spine.

Thoracic spine fractures in patients with AS are not always amenable to sufficient spinal correction/instrumented fusion. Here, a 50-year-old male with AS following a T10 total fracture/dislocation, whose fusion construct failed, was sufficiently stabilized secondary to spontaneous T10-T11 intercostal fusion.