Successful Nonoperative Treatment of a Lumbar Spine Extension Injury with Disruption of all Three Bony Columns in a Patient with Ankylosing Spondylitis – A Case Report

STUDY DESIGN: A case report. BACKGROUND: Patients with ankylosing spondylitis have altered spinal biomechanics putting them at increased risk of spinal fractures that are unstable. As a result there is an increasing trend to treat these fractures with surgical stabilization. We hypothesize that the fracture pattern is also an important factor in patients with this disease and that those with an extension injury in the lumbar spine can be treated with brace immobilization. OBJECTIVE: Report on the non-operative management of an elderly patient, with ankylosing spondylitis, who sustained an extension injury of all three bony columns of the lumbar spine. METHODS: A case report of a 70-year-old man who fell from a standing height, sustaining a three-column fracture at L1-2, who did not want surgical stabilization. RESULTS: External brace immobilization was used and the patient was closely monitored. At his final 13 month follow-up, the patient had no clinical evidence of spinal instability or neurologic compromise and radiologically we could see callous formation anteriorly and laterally between the L1 and L2 vertebral bodies.These bridged the trebeculae across the middle and posterior columns at L1 and L2 on the lateral view, and there was no change in the sagittal or coronal alignment" to "There was mature bridging bone across the middle and posterior columns at L1 and L2 on the lateral view, and there was no change in the sagittal or coronal alignment CONCLUSION: This case supports our hypothesis that the fracture pattern is an important factor in patients with ankylosing spondylitis and adds to the body of knowledge in the scientific literature concerning non-operative treatment of fractures in patients with ankylosed spines. Further study is required to determine whether ours is an isolated case or whether this applies to a wider population of ankylosing spondylitis patients.