Ankylosing spondylitis - specific aspects related to surgical treatment of cervical fracture - case report.

Ankylosing spondylitis (AS) or else Bechterews or Marie-Strümpells disease is a chronic inflammatory autoimmune disease affecting preferentially the spine in the form of sacroileitis and spondylitis [1,2]. Due to acquired skeletal fragility, compared to healthy spine there is a significantly different response of the organism to the mechanical load [3] and therefore in patients with AS, spinal trauma is much more dangerous. Unlike predominantly elastic injuries in healthy cervical spine in AS patients this elasticity is lost and the spine then behaves like a tubular bone [4,5]. A simple X-ray picture is often insufficient because these fractures are difficult to be found in the field of extensive bone alterations typical for AS [6,7,8]. We present a case report of cervical spondylogenic myelopathy in posttraumatic pseudoarthrosis with a prolapse of C6/7 in the field of an old fracture in an AS patient with a typical initial underestimation of diagnosis in minor trauma. The patient therefore experienced a typical late deterioration of the neurological condition. At our department, we have completed the diagnosis and proceeded to perform the surgery with which we have the greatest experience. Although slightly at variance with established procedures, the surgery provides a sufficient solution for the patient also in postoperative follow-up.