Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

Abstract

For patients with AS and lower cervical spine fractures, surgical methods have mainly included the single anterior approach, single posterior approach, and combined anterior-posterior approach. However, various surgical procedures were utilized because the fractures have not been clearly classified according to presence of displacement in these previous studies. Consequently, controversies have been raised regarding the selection of the surgical procedure. This study retrospective analysis was conducted in 12 patients with AS and lower cervical spine fractures and dislocations and explored single-session combined anterior-posterior approach for the treatment of AS with obvious displaced lower cervical spine fractures and dislocations which has demonstrated advantages such as good stabilization, satisfied fracture healing, and easy postoperative cares. However, to some extent, the difficulty and risk of this approach should be considered. Attention should be paid to the prevention of perioperative complications.

Figure 1

(a) A 48-year-old male was admitted to the hospital because of a car accident. The x-ray shows a typical presentation of AS. (b) Cervical CT scan showing fracture and dislocation of C6-C7, anterior defect of C7, fracture of posterior spinous process, and fracture fragments in the spinal canal. (c) MRI showing a long T2 signal in the intervertebral disc space of C6-C7 and the anterior vertebrae body, a sign of the spinal cord compression. (d, e, f) X-ray and CT scan 3 months after surgery showing good position of the internal fixation and healed fracture.

Figure 2

A 53-year-old male was admitted due to sensory-motor disorders of the 4 extremities caused by car accident injuries. (a, b) Anteroposterior and lateral views of an x-ray showing a C6-C7 fracture and dislocation. (c) Sagittal view showing the obviously displaced fracture and dislocation of C6-C7. (d) MRI showing a long T1 signal in the anterior cervical spine. (e, f) Anteroposterior and lateral views showing good position of internal fixation and good reduction. (g) Oesophagoscopy showing a suspicious finding of the tracheoesophageal fistula. (h) Compression of the soft tissue anterior to C6 caused by vertebral fracture fragments (yellow arrow).