Acute Cervical Fractures in Ankylosing Spondylitis

Abstract

In Brief Study Design. A new technique for the management of traumatic cervical fracture in patients with chin-on-chest deformity in ankylosing spondylitis is presented. Objective. To present a new surgical technique for acute deformity correction through cervical fractures in the setting of kyphotic deformities. Summary of Background Data. Cervicothoracic kyphotic deformity in ankylosing spondylitis is currently treated with extension osteotomy in an elective setting. In elective extension osteotomies, the surgeon manipulates the head to generate osteoclasis, temporarily producing an unstable cervical fracture. Cervical fractures in ankylosing spondylitis are highly unstable and frequently associated with neurologic compromise. Most reports describe either no reduction and fixation in situ or reduction in preoperative traction followed by fixation. Methods. A 60-year-old man with chronic ankylosing spondylitis and profound kyphotic deformity suffered a traumatic lower cervical spine fracture. He was treated with an acute cervical spine extension osteotomy through the fracture site using an anterior lengthening bar modification to a halo vest. The anterior lengthening bar allows controlled extension of the neck without manual manipulation by the surgeon. Results. This patient presented with a chin-brow angle of approximately 90° and was corrected to approximately 5° to 8°. No immediate or delayed complications were seen. After halo vest treatment for 3 months, an excellent postural correction was obtained. Conclusion. Surgical extension osteotomy in the lower cervical spine through the fracture site using the anterior lengthening bar-halo extension brace seems to be a safe method for correcting spine flexion deformity in ankylosing spondylitis after traumatic fracture. Acute cervical fractures in patients with preexisting chin-on-chest deformity in ankylosing spondylitis can be treated with a gradual and controlled extension osteotomy through the fracture site, using an anterior lengthening bar modification to a halo vest. This method seems to be a safe, effective treatment for cervical spine fracture in ankylosing spondylitis.