Arjun S Sebastian1, Jeremy L Fogelson1, Mark B Dekutoski1, Ahmad N Nassr2. 1. The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA. 2. The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA. Electronic address: Nassr.ahmad@mayo.edu.
Abstract
BACKGROUND CONTEXT: Spinal fractures occur with a greater frequency in ankylosing spondylitis (AS) patients. Treatment of these fractures is complicated because of a higher incidence of medical comorbidities, higher rate of neurologic deficits, and higher risk of neurologic deterioration. PURPOSE: To report a case report of a novel, combined open and percutaneous surgical techniques used for the treatment of multiple noncontiguous spinal fractures in a patient with AS. STUDY DESIGN/ SETTING: We describe the surgical treatment and the outcome of a patient with AS that sustained an occipitocervical dislocation and two noncontiguous three-column extension injuries using a hybrid technique with open occipital to T3 fusion and percutaneous T5-L1 instrumentation at a tertiary care facility. PATIENT SAMPLE: A 77-year-old man with multiple comorbidities and newly diagnosed AS. OUTCOME MEASURES: Two-year clinical and radiographic outcome of a patient treated surgically for multiple spine injuries in the setting of an ankylosed spine. METHODS: The patient was treated with a hybrid approach using both open fusion and percutaneous instrumentation techniques. RESULTS: At 2 years postoperatively, the patient had recovered ambulatory ability and had a good clinical outcome. CONCLUSIONS: We describe a unique case of noncontiguous spinal trauma in a medically complex patient with AS treated with a hybrid open and percutaneous technique to minimize surgical insult and blood loss, with a good clinical and radiographic outcome 2 years postoperatively.
BACKGROUND CONTEXT: Spinal fractures occur with a greater frequency in ankylosing spondylitis (AS) patients. Treatment of these fractures is complicated because of a higher incidence of medical comorbidities, higher rate of neurologic deficits, and higher risk of neurologic deterioration. PURPOSE: To report a case report of a novel, combined open and percutaneous surgical techniques used for the treatment of multiple noncontiguous spinal fractures in a patient with AS. STUDY DESIGN/ SETTING: We describe the surgical treatment and the outcome of a patient with AS that sustained an occipitocervical dislocation and two noncontiguous three-column extension injuries using a hybrid technique with open occipital to T3 fusion and percutaneous T5-L1 instrumentation at a tertiary care facility. PATIENT SAMPLE: A 77-year-old man with multiple comorbidities and newly diagnosed AS. OUTCOME MEASURES: Two-year clinical and radiographic outcome of a patient treated surgically for multiple spine injuries in the setting of an ankylosed spine. METHODS: The patient was treated with a hybrid approach using both open fusion and percutaneous instrumentation techniques. RESULTS: At 2 years postoperatively, the patient had recovered ambulatory ability and had a good clinical outcome. CONCLUSIONS: We describe a unique case of noncontiguous spinal trauma in a medically complex patient with AS treated with a hybrid open and percutaneous technique to minimize surgical insult and blood loss, with a good clinical and radiographic outcome 2 years postoperatively.
Authors: Cara L Sedney; Scott D Daffner; Abimbola Obafemi-Afolabi; Daniel Gelb; Steven Ludwig; Sanford E Emery; John C France Journal: Int J Spine Surg Date: 2016-06-07