Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur - A Case Report -

Jae Won You; Sin Wook Kang; Hong Moon Sohn

doi:10.4184/jkss.2017.24.4.246

Journal List > J Korean Soc Spine Surg > v.24(4) > 1076150

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You, Kang, and Sohn: Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur - A Case Report -

Case Report

Journal of Korean Spine Surg 2017;24(4):246-251.

Published online: 31 December 2017

DOI: https://doi.org/10.4184/jkss.2017.24.4.246

Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur - A Case Report -

Jae Won You, M.D., Sin Wook Kang, M.D., Hong Moon Sohn, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea

Corresponding author: Hong Moon Sohn, M.D. ORCID ID: Jae Won You: https://orcid.org/0000-0002-7306-9813 Sin Wook Kang: https://orcid.org/0000-0003-0784-5076 Hong Moon Sohn: https://orcid.org/0000-0002-2121-9162 Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmundae-ro, Dong-gu, Gwangju, 61453, Republic of Korea TEL: +82-62-220-3147, FAX: +82-62-226-3379 E-mail: hmsohn@chosun.ac.kr

^∗ This study was supported by a research fund from Chosun University Hospital, 2013.

Received 28 August 20175 September 2017 Accepted 1 November 2017

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

Abstract

Study Design

Case report.

Objectives

To report a case of paraplegia in a patient with thoracic kyphosis after osteosynthesis for a fracture of the femur.

Summary of the Literature Review

There are few reports about cases of paraplegia after low extremity fracture surgery in patients with thoracic kyphosis with ankylosing spondylitis.

Materials and Methods

An 86-year-old female patient presented with right hip pain. She had undergone surgery for an intertrochanteric fracture of the femur in the supine position under general anesthesia. Immediately after surgery, she showed paraplegia. Postoperative thoracolumbar spine images revealed a fracture through the disc at T12 and L1. However, she did not complain of back pain or any neurologic deficits before surgery.

Results

Although the patient underwent emergent posterior decompression and fusion surgery, her neurologic compromise did not improve during 1 year of follow-up.

Conclusions

It is necessary to check preoperative spine radiographs before surgery in elderly patients who have a kyphotic deformity and lower extremity fractures. Surgeons should consider changing the position of the patient and the type of anesthesia used during surgery when spine stability is in doubt.

Keywords: Ankylosing spondylitis, Spine fracture, Lower extremity fracture, Paraplegia, Thoracic kyphosis

REFERENCES

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Fig. 1.

An intertrochanteric fracture of the right femur (Boyd-Griffin type II, Evans unstable) is observed on a preoperative pelvic radiograph (A). Postoperative pelvic radiographs show that the fracture was fixed by a cephalomedullary nail (B).

Fig. 2.

Lumbar spine radiography before hip surgery showed bamboo spine with extensive fusion across the entire spine (A). On the lateral view, there was a gap between T12 and L1 (B). Thoracolumbar lateral spine radiographs after hip surgery show a more displaced thoracolumbar fracture and deviated spine alignment (C).

Fig. 3.

A 3-dimensional reconstructed computed tomography scan after hip surgery revealed a wide range of upper and lower vertebral fusion and worsening of the thoracolumbar fracture in the anteroposterior view (A) and lateral view (B).

Fig. 4.

Magnetic resonance imaging after hip surgery showed a discontinuity of the spinal canal due to fracture and dislocation of T12-L1 (A) and severe canal compromise (B).

Fig. 5.

Thoracolumbar spine radiographs after the emergent spine operation showed posterior instrumentation and posterolateral fusion of T11-L4 and restoration of the spine alignment in anteroposterior (A) and lateral views (B).

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