No abstract

Two cases of cervical fracture-dislocation causing neurological deficits in patients with ankylosing spondylitis are presented. Review of the literature shows that these patients have a higher incidence of neurological deficits (70%) than comparable patients without ankylosing spondylitis (44%). Predisposing factors and treatment are discussed. KEY WORDSankylosing spondylitis cervical fracture-dislocation instability skeletal traction neurological deficit T t-rE high incidence of neurological deficits in patients with ankylosing spondylitis or "bamboo spine" who suffer cervical fracture dislocation is not generally appreciated. Two cases are presented. Case Reports Case 1A 47-year-old man whose spine had been fused in marked flexion from ankylosing spondylitis since 1944 was injured in an automobile accident on December 22, 1969. When seen at a local hospital he had pain and numbness in the left arm and a fracture of C6-7, but was otherwise neurologically intact. He was placed in a Thomas collar and transferred to Crawford Long Hospital in Atlanta, Georgia, for further treatment.Examination. There was weakness of the left triceps and wrist extensors, and hypesthesia over the C-7 and C-8 dermatomes of the left hand. Any motion of the head caused severe pain in the shoulders, most marked on the left. The remainder of the neurological examination was normal. Cervical spine films showed a through-andthrough horizontal fracture of the seventh cervical vertebral body and fused posterior elements and ligaments (Fig. l left). The patient wished to avoid skeletal traction and was therefore kept in the Thomas cervical collar. On December 23, he noticed "tingling" in his legs, although objective sensory and motor function were still normal, and about 3 hours later developed a C6-7 level quadriplegia. X-ray films demonstrated an anterior subluxation of C-6 on C-7, and the patient was taken to the operating room.Operation. With the patient in the sitting position under local anesthesia, Crutchfield tongs were inserted and 35 lbs of traction applied vertically; there was prompt relief of shoulder and arm pain. He was then 76,4 J. Neurosurg. / Volume 39 / December, 1973

No abstract

No abstract