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Article: Multiple and simultaneous spine fractures in ankylosing spondylitis: Case report

TitleMultiple and simultaneous spine fractures in ankylosing spondylitis: Case report
Authors
KeywordsAnkylosing spondylitis
Fracture
Multiple
Noncontiguous
Simultaneous
Spinal cord injury
Spine
Surgery
Issue Date2005
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2005, v. 30 n. 23, p. E711-E715 How to Cite?
AbstractStudy Design. A case report. Objective. To report the unique occurrence and treatment of multiple and simultaneous spine fractures in a patient with progressed ankylosing spondylitis and preexisting multilevel spine instrumentation. Summary of Background Data. Ankylosing spondylitis is a complex inflammatory arthritic condition that renders the spine more susceptible to fracture than individuals who do not have ankylosing spondylitis. To our knowledge, in the patient with ankylosing spondylitis, the occurrence of nonregion-specific multiple and simultaneous spine fractures, and the role of internal instrumentation in subsequent fracture development have not been addressed in the literature. Methods. An 81-year-old white male with ankylosing spondylitis had 2 low-energy falls, resulting in 3 spine fractures. During the first fall, he had a displaced fracture at the T11-T12 level without a spinal cord injury. Fracture treatment entailed posterior instrumentation with fusion at T8-L2 and immobilization after surgery with a thoracolumbosacral orthosis brace, which led to successful healing of the injury. Approximately 2 years later, the patient had a second fall, and presented with simultaneous displaced fractures at the C6-C7 and L2-L3 levels, and an American Spinal Injury Association-A spinal cord injury. The cervical and lumbar fractures were both treated operatively via a 2-staged approach with posterior segmental instrumentation and fusion at C3-T3 and at L2-L5, respectively. A soft cervical collar and a thoracolumbosacral orthosis brace were worn after surgery. There were no intraoperative complications. Results. Although anatomic reduction and stable fixation of the spinal injuries were achieved, the patient's neurologic status following the second injury remained unchanged. His postoperative course was complicated by pulmonary failure that ultimately resulted in death by the 3-month postoperative time. Conclusions. Patients with ankylosing spondylitis have a strong susceptibility to spine fracture from minor trauma, which can have devastating outcomes. Nonregion-specific multiple and simultaneous spine fractures can occur, and require thorough radiographic evaluation with imaging of the entire spinal axis, appropriate operative planning, and meticulous perioperative treatment. Preexisting internal spine instrumentation may predispose the ankylosing spondylitis spine to multiple fractures, even following a minor traumatic event. As such, the clinician should be cognizant of the possible existence of multiple and simultaneous fractures in patients with ankylosing spondylitis with preexisting internal spine instrumentation. ©2005, Lippincott Williams & Wilkins, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/92890
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorAnderson, DGen_HK
dc.contributor.authorShen, FHen_HK
dc.date.accessioned2010-09-22T05:02:52Z-
dc.date.available2010-09-22T05:02:52Z-
dc.date.issued2005en_HK
dc.identifier.citationSpine, 2005, v. 30 n. 23, p. E711-E715en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92890-
dc.description.abstractStudy Design. A case report. Objective. To report the unique occurrence and treatment of multiple and simultaneous spine fractures in a patient with progressed ankylosing spondylitis and preexisting multilevel spine instrumentation. Summary of Background Data. Ankylosing spondylitis is a complex inflammatory arthritic condition that renders the spine more susceptible to fracture than individuals who do not have ankylosing spondylitis. To our knowledge, in the patient with ankylosing spondylitis, the occurrence of nonregion-specific multiple and simultaneous spine fractures, and the role of internal instrumentation in subsequent fracture development have not been addressed in the literature. Methods. An 81-year-old white male with ankylosing spondylitis had 2 low-energy falls, resulting in 3 spine fractures. During the first fall, he had a displaced fracture at the T11-T12 level without a spinal cord injury. Fracture treatment entailed posterior instrumentation with fusion at T8-L2 and immobilization after surgery with a thoracolumbosacral orthosis brace, which led to successful healing of the injury. Approximately 2 years later, the patient had a second fall, and presented with simultaneous displaced fractures at the C6-C7 and L2-L3 levels, and an American Spinal Injury Association-A spinal cord injury. The cervical and lumbar fractures were both treated operatively via a 2-staged approach with posterior segmental instrumentation and fusion at C3-T3 and at L2-L5, respectively. A soft cervical collar and a thoracolumbosacral orthosis brace were worn after surgery. There were no intraoperative complications. Results. Although anatomic reduction and stable fixation of the spinal injuries were achieved, the patient's neurologic status following the second injury remained unchanged. His postoperative course was complicated by pulmonary failure that ultimately resulted in death by the 3-month postoperative time. Conclusions. Patients with ankylosing spondylitis have a strong susceptibility to spine fracture from minor trauma, which can have devastating outcomes. Nonregion-specific multiple and simultaneous spine fractures can occur, and require thorough radiographic evaluation with imaging of the entire spinal axis, appropriate operative planning, and meticulous perioperative treatment. Preexisting internal spine instrumentation may predispose the ankylosing spondylitis spine to multiple fractures, even following a minor traumatic event. As such, the clinician should be cognizant of the possible existence of multiple and simultaneous fractures in patients with ankylosing spondylitis with preexisting internal spine instrumentation. ©2005, Lippincott Williams & Wilkins, Inc.en_HK
dc.languageengen_HK
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.subjectAnkylosing spondylitisen_HK
dc.subjectFractureen_HK
dc.subjectMultipleen_HK
dc.subjectNoncontiguousen_HK
dc.subjectSimultaneousen_HK
dc.subjectSpinal cord injuryen_HK
dc.subjectSpineen_HK
dc.subjectSurgeryen_HK
dc.titleMultiple and simultaneous spine fractures in ankylosing spondylitis: Case reporten_HK
dc.typeArticleen_HK
dc.identifier.emailSamartzis, D:dspine@hku.hken_HK
dc.identifier.authoritySamartzis, D=rp01430en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/01.brs.0000188272.19229.74en_HK
dc.identifier.pmid16319741en_HK
dc.identifier.scopuseid_2-s2.0-28844457288en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-28844457288&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume30en_HK
dc.identifier.issue23en_HK
dc.identifier.spageE711en_HK
dc.identifier.epageE715en_HK
dc.identifier.eissn1528-1159-
dc.identifier.isiWOS:000233807800022-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSamartzis, D=34572771100en_HK
dc.identifier.scopusauthoridAnderson, DG=9633528400en_HK
dc.identifier.scopusauthoridShen, FH=7201583245en_HK

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