Acute Epidural Hematoma Following Cervical Spinal Fracture in a Patient with Ankylosing Spondylitis

Sang Bum Kim; Youn Moo Heo; Byung Hak Oh; Tae Gyun Kim; You Sun Jung

doi:10.4184/jkss.2017.24.1.44

Journal List > J Korean Soc Spine Surg > v.24(1) > 1076154

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Heo, Oh, Kim, and Jung: Acute Epidural Hematoma Following Cervical Spinal Fracture in a Patient with Ankylosing Spondylitis

Case Report

Journal of Korean Spine Surg 2017;24(1):44-48.

Published online: 31 March 2017

DOI: https://doi.org/10.4184/jkss.2017.24.1.44

Acute Epidural Hematoma Following Cervical Spinal Fracture in a Patient with Ankylosing Spondylitis

Sang Bum Kim, M.D., Youn Moo Heo, M.D., Byung Hak Oh, M.D., Tae Gyun Kim, M.D., You Sun Jung, M.D.

Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea

Corresponding author: Byung-Hak Oh, M.D. Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, KoreaDaejeon, Korea TEL: +82-42-600-9863, FAX: +82-42-600-9090 E-mail: sebslab@hanmail.net

Received 12 August 201627 October 2016 Accepted 2 February 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 epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.

Summary of Literature Review

An early surgical intervention for acute epidural hematoma following cervical spinal fracture led to improvements in the patient's neurological deficits.

Materials and Methods

A 76-year-old male with ankylosing spondylitis presented with neck pain and motor weakness of both upper and lower extremities after falling. He sustained fractures of the C7 body and the spinous processes of C5 and C6. Magnetic resonance imaging showed an extensive epidural hematoma from C7 to T5. The authors performed decompression from C6 to T2, and posterior instrumentation and fusion from C4 to T3.

Results

An urgent surgical intervention was performed, and a good result was obtained.

Conclusions

The authors describe an early surgical intervention in a case of acute epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.

Keywords: Ankylosing spondylitis, Epidural hematoma, Cervical spinal fracture

REFERENCES

1. Qunfeng G, Yidong C, Liang W, et al. Single anterior approach for cervical spine fractures at C5-T1complicating ankylosing spondylitis. Clinical neurology and Neurosurgery. 2016; 147:1–5.

2. Gourav G, Rambir S, Kishan R. Anticoagulant induced spontaneous spinal epidural hematoma, conservative management or surgical intervention A dilemma. J. Acute medicine. 2016; 6:38–42.

3. Mundwiler ML, Siddique K, Dym JM, et al. Complications of the spine in ankylosing spondylitis with a focus on deformity correction. Neurosurgical Focus. 2008; 24:E6.

4. Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and Complications. Eur Spine J. 2009; 18:145–56.

5. Vosse D, Feldtkeller E, Erlendsson J, et al. Clinical vertebral fractures in patients with ankylosing spondylitis. J Rheuma-tology. 2004; 31:1981–5.

6. Gartman JJ Jr, Bullitt E, Baker ML. Axis fracture in ankylosing spondylitis: case report. Neurosurgery. 1991; 29:590–4.

7. Duffill J, Sparrow OC, Millar J, et al. Can spontaneous spinal epidural hematoma be managed safely without operation? A report of four cases. J Neurol Neurosurg Psychiatry. 2000; 69:816–9.

8. Chaudhary SB, Hullinger H, Michael JV. Management of Acute Spinal Fractures in Ankylosing Spondylitis. ISRN Rheumatol. 2011 Jun 30.

9. Chong KH, Hsu HT, Tu CW, et al. Spontaneous spinal epidural hematoma: Early surgical intervention pro-vides ideal neurological outcome. Formosan J of Surgery. 2014; 47:156–9.

10. Jeon TS, Chung WY, Lee WS, et al. Spinal Epidural Hematoma Associated with Cervical Fracture in Ankylosing Spondylitis. J Korean spine surg. 2003; 10:191–5.

Fig. 1.

Initial radiologic findings taken 2 hours after the trauma. (A) A lateral X-ray shows the ankylosed cervical spine. (B) Computed tomography shows fracture of the C7 body. (C, D) On magnetic resonance imaging, a T2-weighted sagittal view and a Dixon view delineate a posterior epidural lesion with an iso to high signal from C7 to T5, corresponding to acute hematoma.

Fig. 2.

Postoperative radiologic findings. (A) A plain radiograph shows in situ posterior fixation from C4 to T3. (B) Cervical spine computed tomography shows adequate posterior decompression from C6 to T2.

TOOLS

Similar articles