gms | German Medical Science

There are very few data about cervical spine fracture in patients who additionally suffer from Morbus Bechterew. In clinical practice it is difficult to reach a decision to operate or treat conservatively such as placing a halo fixateur because of the exceptional disadvantages of both treatments in this group of patients. On the one hand, it is necessary to fix the broken part of the pre-existing rigid spine, on the other these patients need intensive daily training to prevent stiffening. The operative management differs from the usual treatment of cervical spine fractures. Especially retroflexion of the neck with the risk of dislocation because of biomechanical changes and subsequent neurological deterioration or pain makes the operation hazardous.

In the years 1997 until 2003, five male patients who suffered from Bechterew disease were operated on a cervical spine fracture. The age ranged from 45 to 82 years. All patients had long-term Bechterew disease and the cervical spine showed a clear lack of motion in x-ray and clinical examination.

Four of the patients had neurological deficits when admitted to hospital. In four cases an operation was performed. One patient was primarily treated conservatively with a halo fixateur. In three cases the line of fracture was in the middle of the affected vertebrae. Postoperatively one patient with initial palsy of both arms and legs showed signs of improvement. Two patients could be mobilised to walking on ward floor within one week of hospitalisation. The follow-up of the patient with halo fixateur was five months before removing this device. One patient died because of lung complications following a complete paraplegia at the level C4.

Surgery of cervical spine fracture in patients with Bechterew disease carries a high risk. Special biomechanical characteristics of the rigid spine have to be considered.