Chon Haemin, Park Jin Hoon
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
J Clin Neurosci. 2017 Jul;41:150-153. doi: 10.1016/j.jocn.2017.04.012. Epub 2017 Apr 24.
We describe a patient with ankylosing spondylitis (AS) with cervical spinal fracture treated with cervical pedicle screw placement (CPS) through a single posterior approach. A 43-year-old male patient with AS visited our emergency centre due to paralysis following a trauma. Coronal reconstructed cervical spine computed tomography (CT) scan showed a C5 oblique fracture, and the bilateral pedicles were separated superiorly and inferiorly. The sagittal reconstructed CT image revealed bamboo spine and C5 vertebrae body fracture. Hyperextension between the fractured segments of the C5 body was noted because the fracture gap was anteriorly open. Magnetic resonance imaging (MRI) showed cord compression and injury at the C4-5 level. CPS was performed at the C3-6 levels. Because the left and right pedicles were displaced superiorly and inferiorly, dual compressions between the left C5 and left C6 pedicle screws and between the right C5 and right C4 pedicle screws were performed. Decompression at the C4 and C5 levels was performed after identifying good alignment. This posterior fusion surgery was performed for two hours. After surgery, the radiograph showed complete reduction and fracture gap apposition. The patient was rehabilitated, and his muscle strength improved. Postoperative CT and X-rays revealed complete fracture site fusion and correct CPS position. Considering increased morbidity of long-level or -duration surgery, our fracture body overlapping technique using CPS and posterior only approach seems to be a possible and good surgical method in traumatic cervical fracture with AS.
我们描述了一例强直性脊柱炎（AS）合并颈椎骨折的患者，通过单一后路行颈椎椎弓根螺钉置入（CPS）治疗。一名43岁的AS男性患者因外伤后瘫痪前来我院急诊中心就诊。颈椎冠状位重建计算机断层扫描（CT）显示C5斜行骨折，双侧椎弓根上下分离。矢状位重建CT图像显示竹节样脊柱和C5椎体骨折。由于骨折间隙前方开放，可见C5椎体骨折节段间存在过伸。磁共振成像（MRI）显示C4-5水平脊髓受压和损伤。在C3-6水平行CPS。由于左右椎弓根上下移位，在左侧C5和左侧C6椎弓根螺钉之间以及右侧C5和右侧C4椎弓根螺钉之间进行了双重加压。在确认对位良好后，在C4和C5水平进行减压。该后路融合手术持续了两个小时。术后X线片显示骨折完全复位，骨折间隙对合。患者接受康复治疗，肌肉力量有所改善。术后CT和X线显示骨折部位完全融合，CPS位置正确。考虑到长节段或长时间手术的并发症增加，我们采用CPS和仅后路入路的骨折椎体重叠技术似乎是治疗AS合并创伤性颈椎骨折的一种可行且良好的手术方法。
