Disclosures: David Frolov, BS: No financial relationships or conflicts of interest

Case Diagnosis: An 80-year-old male with history of kyphotic ankylosing spondylitis (AS) with synostosis of C2-sacrum presenting with complex odontoid fracture status post fall from bed.

Case Description or Program Description: This 80-year-old male with history of kyphotic AS with synostosis of C2-sacrum presented with neck pain following a backwards fall from bed one month prior. AS is an autoimmune arthritic condition presenting with inflammation of the axial skeleton, often progressing to intervertebral synostosis. This patient is a tribal elder and Salish language instructor, from a population of individuals with a higher prevalence of autoimmune disorders. CT scan revealed a dens fracture, bilateral C2 facet fracture, and lateral mass fractures with C1-C2 stenosis. There were spinal cord changes on MRI, but there were no neurological deficits. Following the exhaustion of all conservative management measures, the lifestyle imposition on the patient, on-going neck pain and torticollis, development of a non-functional fracture union, and spinal cord changes on MRI, the treating surgeon was compelled to provide a posterior cervical fusion spanning the occiput to T3.

Setting: Alpine Orthopaedic and Spine, P.C.

Assessment/Results: The patient’s osteoporosis and fragile AS synostosis bone required full occiput-T3 fusion for repair of a complex odontoid fracture. The procedure went well with no significant complications, allowing the patient to resume his tribal roles with no complaints on one year follow-up.

Discussion (relevance): This patient demonstrates a complex case of AS, with mobility confined to occiput-C1 and C1-C2. The low energy fall concentrated forces on the last mobile segments, resulting in a complex odontoid fracture. The patient’s osteoporosis and fragile synostosis required full occiput-T3 fusion to mitigate transitional zone stresses that can occur with a shorter fusion. The fusion was successful, while minimizing pain and allowing the patient to resume his tribal roles.

Conclusions: Full occiput-T3 fusion has validity as surgical management of cervical fractures for patients with AS and osteoporosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/posterior-cervical-fusion-of-occiput-t3-for-unstable-complex-odontoid-fracture-in-80-year-old-male-with-c2-sacrum-synostosis-from-ankylosing-spondylitis-a-case-report-and-review-of-the-literature/