Delayed Neurological Deficit in a Patient with a Compression Fracture of the Thoracic Spine: Coexistence of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis

ABSTRACT

Ankylosing spondylitis(AS) and diffuse idiopathic skeletal hyperostosis(DISH) increase the risk of spinal fracture after minor trauma in an ankylosed spine. There are few reports on a spinal fracture in people with both conditions. A 67-year-old man visited our emergency room with moderate back pain developed after slipping. No neurological deficit was noted. On physical examination, direct tenderness was noted in the back at the level of the thoracolumbar(TL) junction. Radiological evaluations showed the compression fracture of ankylosed spine and the coexistence of AS and DISH. Vertebroplasty was performed in fractured spine due to persistent back pain. Several weeks later, neurological deficits were developed. Finally, decompressive laminectomy and posterior screw fixations were performed. After operation, neurological deficits were fully recovered and patient was discharged. Patient who had a fracture of an ankylosed spine in association with coexisting AS and DISH could be considered the early surgical treatment.