Screw fixation without fusion for low lumbar chance fracture accompanied by spinal epidural hematoma in patient with ankylosing spondylitis

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disease involving the sacroiliac joint and axial spine. AS may render the ankylosed spine prone to trauma and cause an increased frequency of associated epidural hematomas in spine fractures. Herein, we report a rare case of L5 chance fracture and epidural hematoma in a 27-year-old female patient with AS. She was treated surgically but without bone fusion or decompressive laminectomy due to the neurologically intact status despite significant neural compression by the spinal epidural hematoma (SEH). We believe that conservative treatment with close observation of neurological status may be effective in SEH presenting with mild neurological symptoms despite significant neural compression.

Keywords: Ankylosing spondylitis; Chance fracture; Epidural hematoma.

Fig. 1

A) Simple lateral radiograph reveals discontinuity of ossified ligament and displaced L5 fracture. B & C) Computed tomography (CT) scans show vertebral body and posterior element fractures (arrows)

Fig. 2

A) T2-weighted sagittal, B) T1-weighted sagittal, C) fat-suppressed sagittal and D) T2-weighted axial MR images show epidural hematoma extending from L4 to S1 in the posterior part of epidural space

Fig. 3

T2-weighted magnetic resonance (MR) images taken six days after injury show spontaneous regression of hematoma

Fig. 4

A & B) Simple radiographs show short-segment fixation without fusion by percutaneous technique. C & D) Computed tomography scan and lateral radiograph at 8 months postoperative reveal bony union of L5