title: Multiple noncontiguous spinal fractures and occipitocervical dislocation in a patient with ankylosing spondylitis treated with a hybrid open and percutaneous spinal fixation technique: a case report.
abstract: BACKGROUND
  Spinal fractures occur with a greater frequency in ankylosing spondylitis (AS) patients. Treatment of these fractures is complicated because of a higher incidence of medical comorbidities, higher rate of neurologic deficits, and higher risk of neurologic deterioration.
  
  
  OBJECTIVE
  To report a case report of a novel, combined open and percutaneous surgical techniques used for the treatment of multiple noncontiguous spinal fractures in a patient with AS.
  
  
  METHODS
  We describe the surgical treatment and the outcome of a patient with AS that sustained an occipitocervical dislocation and two noncontiguous three-column extension injuries using a hybrid technique with open occipital to T3 fusion and percutaneous T5-L1 instrumentation at a tertiary care facility.
  
  
  METHODS
  A 77-year-old man with multiple comorbidities and newly diagnosed AS.
  
  
  METHODS
  Two-year clinical and radiographic outcome of a patient treated surgically for multiple spine injuries in the setting of an ankylosed spine.
  
  
  METHODS
  The patient was treated with a hybrid approach using both open fusion and percutaneous instrumentation techniques.
  
  
  RESULTS
  At 2 years postoperatively, the patient had recovered ambulatory ability and had a good clinical outcome.
  
  
  CONCLUSIONS
  We describe a unique case of noncontiguous spinal trauma in a medically complex patient with AS treated with a hybrid open and percutaneous technique to minimize surgical insult and blood loss, with a good clinical and radiographic outcome 2 years postoperatively.
authors: The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA.
authors: Arjun S
authors: AS
authors: Sebastian
authors: The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA.
authors: Jeremy L
authors: JL
authors: Fogelson
authors: The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA.
authors: Mark B
authors: MB
authors: Dekutoski
authors: The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA. Electronic address: Nassr.ahmad@mayo.edu.
authors: Ahmad N
authors: AN
authors: Nassr
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013167:Spondylitis, Ankylosing / Q000150:complications
keywords: Ankylosing spondylitis; Hybrid technique; Minimally invasive techniques; Occipital-cervical dislocation; Percutaneous fixation; Spinal fractures