Jung Ki Tae, So Keum Young, Jang Bo Hyun, Kim Sang Hun
Department of Anaesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea.
Department of Anaesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea.
Turk J Anaesthesiol Reanim. 2020 Apr;48(2):160-164. doi: 10.5152/TJAR.2019.72368. Epub 2019 Nov 25.
Ankylosing spondylitis (AS) is vulnerable to fracture, and the missed diagnosis can lead to neurological deterioration. Herein, we present the conus medullaris syndrome due to aggravation of the missed spinal fracture in an 85-year-old woman with AS who underwent hip surgery. She underwent osteosynthesis in a supine position with supports under her shoulders and head due to spine deformity with AS, but was fully supine without supports after surgery. She showed complete paraplegia at postoperative 12 h. The re-reading radiological imaging showed the missed spinal fracture, of which the deteriorated dislocation was revealed on the re-examined radiological evaluation. This deterioration was not recovered ultimately despite an emergent surgery. A thorough preoperative assessment is essential to prevent the missed diagnosis of spinal fracture and minimise deterioration due to its dislocation, with specific spine precaution during transport, transfer and positioning.
强直性脊柱炎（AS）易发生骨折，漏诊可导致神经功能恶化。在此，我们报告一例85岁AS女性患者，因髋部手术时漏诊的脊柱骨折加重而出现圆锥综合征。由于AS导致脊柱畸形，她在仰卧位且肩部和头部有支撑的情况下进行了骨固定术，但术后完全仰卧且无支撑。术后12小时她出现了完全性截瘫。再次阅读影像学检查显示存在漏诊的脊柱骨折，再次检查的影像学评估显示骨折移位恶化。尽管进行了急诊手术，但这种恶化最终未能恢复。全面的术前评估对于预防脊柱骨折的漏诊以及将因其移位导致的恶化降至最低至关重要，在转运、转移和安置过程中要采取特定的脊柱防护措施。
