Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis

Abstract

This case report illustrates three learning points about cervical fractures in ankylosing spondylitis, and it highlights the need to manage these patients with the neck initially stabilised in flexion. We describe a case of cervical pseudoarthrosis that is a rare occurrence after fracture of the cervical spine with ankylosing spondylitis. This went undetected until the development of myelopathic symptoms many months later. The neck was initially stabilised in flexion using tongs, and then slowly extended before anterior and posterior fixation was performed. The myelopathic symptoms resolved, and the patient had a good result at 18 months. We conclude that any increased movement of the spine after trauma in ankylosing spondylitis must be considered suspect and fully investigated.

Fig. 1

Lateral radiograph of the cervical spine showing pseudoarthrosis with destruction of the body of C7

Fig. 2

Diagrammatic representation of traction applied with the cervical spine in flexion

Fig. 3

Mid-sagittal MRI scan of the cervical spine showing fluid attenuation in the cyst replacing the body of C7

Fig. 4

Lateral radiograph of the cervical spine showing the plate, with screw fixation into the body of C6, and the block of bone graft (arrow)