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Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report

Received: 30 January 2024     Accepted: 18 February 2024     Published: 29 February 2024
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Abstract

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that affects the sacroiliac joints and surrounding joints. It is a seronegative spondyloarthritis that invades connective tissue. Managing cervical spine fractures in patients with AS is particularly challenging due to the severity of the deformity and the instability of the fracture. Cervical spine fracture combined with spinal cord injury is the leading cause of death and is strongly correlated with in-hospital mortality in patients with ankylosing spondylitis. There have been limited reports on the revision of cervical spine fractures after internal fixation in patients with AS. The case report is about a patient who is a 34-year-old man who underwent emergency surgery at a local hospital for a cervical spine fracture resulting from a car accident. A postoperative review revealed that the anterior internal fixation was detached, leading to a revision surgery being performed according to the patient's actual condition. Unfortunately, the internal fixation became dislodged fol-lowing the initial surgery, exacerbating the patient's condi-tion and leading to the development of pneumonia. In order to prevent the need for revision surgery, it is crucial to carefully evaluate and determine the most suitable surgical approach for patients with cervical spine fractures and spinal cord injury before proceeding with the initial surgery.

Published in Journal of Surgery (Volume 12, Issue 1)
DOI 10.11648/j.js.20241201.12
Page(s) 5-10
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Ankylosing Spondylitis, Cervical Spine, Dislocation, Fracture, Revision

References
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[2] HUNTER T, DUBO H. Spinal fractures complicating ankylosing spondylitis [J]. Ann Intern Med, 1978, 88(4): 546-9.
[3] GARG K, RAFIQ R, MISHRA S, et al. Cervical Spine Fracture with Extreme Dislocation in a Patient with Ankylosing Spondylitis: A Case Report and Systematic Review of the Literature [J]. Neurol India, 2022, 70(Supplement): S296-S301.
[4] KANDREGULA S, BIRK H S, SAVARDEKAR A, et al. Spinal Fractures in Ankylosing Spondylitis: Patterns, Management, and Complications in the United States - Analysis of Latest Nationwide Inpatient Sample Data [J]. Neurospine, 2021, 18(4): 786-97.
[5] VERLA T, XU D S, DAVIS M J, et al. Failure in Cervical Spinal Fusion and Current Management Modalities [J]. Semin Plast Surg, 2021, 35(1): 10-3.
[6] LUKASIEWICZ A M, BOHL D D, VARTHI A G, et al. Spinal Fracture in Patients With Ankylosing Spondylitis: Cohort Definition, Distribution of Injuries, and Hospital Outcomes [J]. Spine (Phila Pa 1976), 2016, 41(3): 191-6.
[7] LONGO U G, LOPPINI M, PETRILLO S, et al. Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach? [J]. Br Med Bull, 2015, 115(1): 57-66.
[8] MA J, WANG C, ZHOU X, et al. Surgical Therapy of Cervical Spine Fracture in Patients With Ankylosing Spondylitis [J]. Medicine (Baltimore), 2015, 94(44): e1663.
[9] TAGGARD D A, TRAYNELIS V C. Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation [J]. Spine (Phila Pa 1976), 2000, 25(16): 2035-9.
[10] DVORAK M F, FISHER C G, FEHLINGS M G, et al. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system [J]. Spine (Phila Pa 1976), 2007, 32(23): 2620-9.
[11] GOVINDARAJAN V, BRYANT J P, PEREZ-ROMAN R J, et al. The role of an anterior approach in the treatment of ankylosing spondylitis-associated cervical fractures: a systematic review and meta-analysis [J]. Neurosurg Focus, 2021, 51(4): E9.
[12] FELTELIUS N, HEDENSTROM H, HILLERDAL G, et al. Pulmonary involvement in ankylosing spondylitis [J]. Ann Rheum Dis, 1986, 45(9): 736-40.
[13] COOPER P R, COHEN A, ROSIELLO A, et al. Posterior stabilization of cervical spine fractures and subluxations using plates and screws [J]. Neurosurgery, 1988, 23(3): 300-6.
[14] EXNER G, BOTEL U, KLUGER P, et al. Treatment of fracture and complication of cervical spine with ankylosing spondylitis [J]. Spinal Cord, 1998, 36(6): 377-9.
[15] EINSIEDEL T, SCHMELZ A, ARAND M, et al. Injuries of the cervical spine in patients with ankylosing spondylitis: experience at two trauma centers [J]. J Neurosurg Spine, 2006, 5(1): 33-45.
[16] CORNEFJORD M, ALEMANY M, OLERUD C. Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis [J]. Eur Spine J, 2005, 14(4): 401-8.
[17] DUHEM-TONNELLE V, DUHEM R, ALLAOUI M, et al. [Fracture luxation of the cervical spine in patients with ankylosing spondylitis: six cases] [J]. Neurochirurgie, 2008, 54(1): 46-52.
[18] SHETTY A P, MURUGAN C, KARUPPANNAN SUKUMARAN S V A, et al. Surgical Approach to Cervical Fractures in Ankylosing Spondylitis Patients: Rationale and Surgical Strategy [J]. World Neurosurg, 2023, 173: e321-e8.
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Cite This Article
  • APA Style

    Wu, J., Xiao, Y., Lin, H., Ji, Z., Zhang, G. (2024). Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report. Journal of Surgery, 12(1), 5-10. https://doi.org/10.11648/j.js.20241201.12

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    ACS Style

    Wu, J.; Xiao, Y.; Lin, H.; Ji, Z.; Zhang, G. Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report. J. Surg. 2024, 12(1), 5-10. doi: 10.11648/j.js.20241201.12

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    AMA Style

    Wu J, Xiao Y, Lin H, Ji Z, Zhang G. Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report. J Surg. 2024;12(1):5-10. doi: 10.11648/j.js.20241201.12

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  • @article{10.11648/j.js.20241201.12,
      author = {Jianxiong Wu and Yongchun Xiao and Hongsheng Lin and Zhisheng Ji and Guowei Zhang},
      title = {Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report},
      journal = {Journal of Surgery},
      volume = {12},
      number = {1},
      pages = {5-10},
      doi = {10.11648/j.js.20241201.12},
      url = {https://doi.org/10.11648/j.js.20241201.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20241201.12},
      abstract = {Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that affects the sacroiliac joints and surrounding joints. It is a seronegative spondyloarthritis that invades connective tissue. Managing cervical spine fractures in patients with AS is particularly challenging due to the severity of the deformity and the instability of the fracture. Cervical spine fracture combined with spinal cord injury is the leading cause of death and is strongly correlated with in-hospital mortality in patients with ankylosing spondylitis. There have been limited reports on the revision of cervical spine fractures after internal fixation in patients with AS. The case report is about a patient who is a 34-year-old man who underwent emergency surgery at a local hospital for a cervical spine fracture resulting from a car accident. A postoperative review revealed that the anterior internal fixation was detached, leading to a revision surgery being performed according to the patient's actual condition. Unfortunately, the internal fixation became dislodged fol-lowing the initial surgery, exacerbating the patient's condi-tion and leading to the development of pneumonia. In order to prevent the need for revision surgery, it is crucial to carefully evaluate and determine the most suitable surgical approach for patients with cervical spine fractures and spinal cord injury before proceeding with the initial surgery.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report
    AU  - Jianxiong Wu
    AU  - Yongchun Xiao
    AU  - Hongsheng Lin
    AU  - Zhisheng Ji
    AU  - Guowei Zhang
    Y1  - 2024/02/29
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    N1  - https://doi.org/10.11648/j.js.20241201.12
    DO  - 10.11648/j.js.20241201.12
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 5
    EP  - 10
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20241201.12
    AB  - Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that affects the sacroiliac joints and surrounding joints. It is a seronegative spondyloarthritis that invades connective tissue. Managing cervical spine fractures in patients with AS is particularly challenging due to the severity of the deformity and the instability of the fracture. Cervical spine fracture combined with spinal cord injury is the leading cause of death and is strongly correlated with in-hospital mortality in patients with ankylosing spondylitis. There have been limited reports on the revision of cervical spine fractures after internal fixation in patients with AS. The case report is about a patient who is a 34-year-old man who underwent emergency surgery at a local hospital for a cervical spine fracture resulting from a car accident. A postoperative review revealed that the anterior internal fixation was detached, leading to a revision surgery being performed according to the patient's actual condition. Unfortunately, the internal fixation became dislodged fol-lowing the initial surgery, exacerbating the patient's condi-tion and leading to the development of pneumonia. In order to prevent the need for revision surgery, it is crucial to carefully evaluate and determine the most suitable surgical approach for patients with cervical spine fractures and spinal cord injury before proceeding with the initial surgery.
    
    VL  - 12
    IS  - 1
    ER  - 

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Author Information
  • Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China

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