Multiple noncontiguous spinal fractures and occipitocervical dislocation in a patient with ankylosing spondylitis treated with a hybrid open and percutaneous spinal fixation technique: a case report

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. (C) 2015 Elsevier Inc. All rights reserved.