Ankylosing spondylitis complicated by cervical spine fracture and cervicothoracic epidural hematoma: A case report.

RATIONALE: Patients with ankylosing spondylitis (AS) are uniquely susceptible to severe cervical spine fractures and spinal epidural hematoma (SEH) following minor trauma, leading to rapid neurological decline. The distinct biomechanical and vascular pathophysiology in AS necessitates tailored surgical management strategies.

PATIENT CONCERNS: A 68-year-old man with a known history of AS presented with acute neck pain and progressive weakness in both lower limbs.

DIAGNOSES: Computed tomography and magnetic resonance imaging revealed a fracture at the C5-7 level, accompanied by an extensive cervical epidural hematoma causing significant spinal cord compression. The diagnoses were cervical spine fracture with incomplete spinal cord injury and traumatic SEH.

INTERVENTIONS: Due to rapid neurological deterioration culminating in grade 0 muscle strength in the lower limbs, urgent surgical intervention was performed. A combined anterior-posterior approach was utilized: anterior C7 subtotal corpectomy with fusion for stabilization, followed by posterior laminectomy for decompression. A novel technique involving gentle evacuation of the hematoma using a specialized dural catheter was employed to restore spinal cord pulsation.

OUTCOMES: Postoperatively, the patient demonstrated significant neurological recovery, achieving grade 4/5 muscle strength in the lower limbs and the ability to walk with a walker. Two-year follow-up confirmed stable instrumentation, normal limb strength, and only transient residual plantar numbness. No major complications such as infection, cerebrospinal fluid leak, or hardware failure occurred.

LESSONS: Early diagnosis and urgent surgical decompression are critical for neurological recovery in AS patients with cervical fractures and SEH. The combined anterior-posterior approach provides effective decompression and robust stabilization. The technique of limited laminectomy with catheter-assisted hematoma evacuation represents an effective minimally invasive strategy for decompression while preserving posterior spinal integrity.