Repetitive Vertebral Fractures in Patients with Ankylosing Spinal Disorders: A Report of Two Cases

• Main Authors: Ryunosuke Fukushi, Satoshi Kawaguchi, Goichi Watanabe, Keiko Horigome, Hideki Yajima, Toshihiko Yamashita
• Format: Article
• Language: English
• Published: The Japanese Society for Spine Surgery and Related Research 2019-04-01
• Series: Spine Surgery and Related Research
• Subjects: Ankylosing spinal disorder; Diffuse idiopathic skeletal hyperostosis; Ankylosing spondylitis; Fracture
• Online Access: https://www.jstage.jst.go.jp/article/ssrr/3/2/3_2018-0017/_pdf/-char/en

Introduction: Vertebral fractures associated with ankylosing spinal disorders pose significant diagnostic and therapeutic challenges. Notably, the ankylosed spine remains in ankylosis after fracture treatment, and the underlying susceptibility to further fractures still remains. Nevertheless, information is scarce in the literature concerning patients with ankylosing spinal disorders who have multiple episodes of vertebral fractures. Case Report: Case 1 involves an 83-year-old male patient with diffuse idiopathic skeletal hyperostosis (ankylosis from C2 to L4) who had three episodes of vertebral fractures. The first episode involved a C5-C6 extension-type fracture, which was treated with posterior segmental screw instrumentation. Five years later, the patient sustained a three-column fracture at the L1 vertebra following another fall. The fracture was managed with percutaneous segmental screw instrumentation. One year and two months postoperatively, the patient fell again and had a refracture of the healed L1 fracture. The patient was treated with a hard brace, and the fracture healed. Case 2 involves a 76-year-old female patient with ankylosing spondylitis (ankylosis from C7 to L2) who had two episodes. At the first episode, she suffered paraplegia due to a T8 vertebra fracture. The patient was treated with laminectomy and posterior segmental screw instrumentation. The patient recovered well and had all the hardware removed at 10 months postoperatively. Five years later, she had another fall and suffered a three-column fracture at L1. The patient underwent percutaneous segmental screw instrumentation. The patient required revision surgery with L1 laminectomy and L1 right pediclectomy for persistent right inguinal pain. At one-year follow-up, the patient recovered well, and the fracture healed. Conclusions: The abovementioned cases show that an age older than 75 years and a long spinal ankylosis from the cervical spine to the lumbar spine may serve as risk factors for the repetition of vertebral fractures associated with ankylosed spinal disorders.