Successful management of a cervical fracture in a patient with ankylosing spondylitis by a posterior approach

Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6–7 fracturedislocation was identified, and the patient underwent emergent open reduction and C4–T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6–T1 decompression and fixation for a C6–7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6–7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members.

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Evaluating a Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spondylitis

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000171 ◽

2017 ◽

Vol 30 (1) ◽

pp. E13-E18 ◽

Cited By ~ 9

Author(s):

Ting Wang ◽

Dechun Wang ◽

Yanan Cong ◽

Chuqiang Yin ◽

Shuzhong Li ◽

...

Keyword(s):

Surgical Treatment ◽

Ankylosing Spondylitis ◽

Posterior Approach

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Iatrogenic Cervical Fracture in a Case with Ankylosing Spondylitis and Rehabilitation Practices

Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi ◽

10.4274/tftr.56.88 ◽

2010 ◽

Vol 56 (2) ◽

pp. 88-90

Author(s):

İlknur Tuğcu ◽

Bilge Yılmaz ◽

Kutay Tezel ◽

Kamil Yazıcıoğlu ◽

Haydar Möhür

Keyword(s):

Ankylosing Spondylitis ◽

Cervical Fracture

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Lateral position and utility of navigation for posterior fixation of unstable cervical fracture with ankylosing spondylitis

Surgical Neurology International ◽

10.4103/sni.sni_250_18 ◽

2018 ◽

Vol 9 (1) ◽

pp. 225

Author(s):

Jason Milton ◽

Zubair Ahammad ◽

Kailash Narayan ◽

Victor Awuor

Keyword(s):

Ankylosing Spondylitis ◽

Lateral Position ◽

Posterior Fixation ◽

Cervical Fracture

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Posterior Fixation of a Cervical Fracture Using the RRS Loop Spine System and Polyethylene Tape in an Elderly Ankylosing Spondylitis Patient: A Case Report

Asian Spine Journal ◽

10.4184/asj.2012.6.1.60 ◽

2012 ◽

Vol 6 (1) ◽

pp. 60 ◽

Cited By ~ 1

Author(s):

Munehisa Koizumi ◽

Jin Iida ◽

Hideki Shigematsu ◽

Nobuhisa Satoh ◽

Masato Tanaka ◽

...

Keyword(s):

Case Report ◽

Ankylosing Spondylitis ◽

Posterior Fixation ◽

Cervical Fracture

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Unanticipated Difficult Airway Management in a Trauma Partient with Severe Ankylosing Spondylitis

10.54137/ijotr112 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Werner Held ◽

Marie Fernando

Keyword(s):

Ankylosing Spondylitis ◽

Difficult Airway ◽

Soft Skills ◽

Difficult Airway Management ◽

Appropriate Use ◽

Successful Management ◽

Trauma Victim ◽

Surgical Tracheostomy ◽

Airway Anatomy ◽

Chronic Arthropathy

Ankylosing Spondylitis is a debilitating chronic arthropathy that affects multiple joints. Anaesthesiologists face significant challenges when dealing with the airway implications of this disease, especially when it is unanticipated that a difficult airway may be encountered. This case describes a 42-year-old trauma victim who required an emergency denitive trachea at his ward. Ankylosing Spondylitis and complex airway anatomy led to his intubation failure. He was eventually given an emergency surgical tracheostomy. The successful management of a difficult airway was possible thanks to the appropriate use of modern airway adjuncts as well as workplace soft skills.

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