Unstable fracture of fusion mass in old healed tuberculous kyphosis: Case report

INTRODUCTION AND IMPORTANCE: Old healed spinal tuberculosis sometimes makes bony ankylosis with kyphotic deformity. This bony ankylosis with adjacent vertebra is like ankylosing spinal disorders (ASDs) such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis. There is lots of report which revealed that conservative management might be failed in thoracolumbar fracture in ASDs. However, there is no report which shows surgical treatment was finally done because conservative management was failed in fracture healing of fusion mass caused by old spinal tuberculosis. CASE PRESENTATION: A 68 year-old male patient has suffered from spinal tuberculosis about fifty years ago and then has bony kyphotic ankylosis. He fell off a ladder and was conducted conservative treatment under diagnosis of a sprain at a doctor's office. He was diagnosed with fracture of fusion mass after computed tomography and magnetic resonance image scans in our hospital due to persistent back pain. At first, he refused operation strongly, but underwent eventually posterior fixation without anterior support and angle correction for persistent pain and fracture nonunion. We finally achieved bone union after postoperative nine months. CLINICAL DISCUSSION: The characteristics of old healed spinal tuberculosis with kyphotic deformity is similar to that of ASDs. The spine fractures among the patients with ASDs can be easily missed. So, Checking whole spine CT or MRI is recommended for fracture screening to ASD patients with back or neck pain after trauma. For unstable AOSpine type B- or C-type injuries, conservative management is not recommended. This recommendations should also apply to patients with spinal tuberculosis. CONCLUSION: In patients with bony kyphotic ankylosis due to spinal tuberculosis, minor trauma can cause unstable fracture. If there's found unstable fracture, surgery should be underwent as soon as possible for preventing neurologic deficits. Hence, we would like to report this case with literature reviews.