Surgical failure in patient with cervical fracture and ankylosing spondylitis treated with teriparatide to try to augment consolidation

摘要

Dear editor:Cervical fractures often require surgical treatment to achieve proper stabilisation and thus prevent neurological damage associated with an unstable cervical spine (Fig. 1).Systemic diseases such as ankylosing spondylitis hinder the surgical treatment of fractures, mainly because of the osteoporosis induced by long-term inmunosupressive and glucocorticoid treatments. They also pose a surgical challenge because the approach is limited by stiffness and kyphotic deformity of cervical spine [7, 10].Teriparatide (1-34 recombinant human parathyroid hormone, Forteo/Forsteo?, Lilly Inc.) is an osteoinductive agent used in the treatment of advanced osteoporosis, and it has been shown to be useful in cases of fractures that are refractory to consolidation [2, 6].We report a 52-year-old male patient with a long history of ankylosing spondylitis, who suffered a whiplash injury, resulting in a C7 fracture. A ventrodorsal approach was used, since the patient did not tolerate a prone position, and we performed a single-level anterior cervical arthrodesis following discectomy at C6C7, with autologous bone graft from the iliac crest. It was not possible to insert an anterior cervical plate. The patient was immobilised for 3 months with a halo jacket and Philadelphia collar.Six months post-operatively, control computed tomography (CT) showed pseudarthrosis at the fracture site, and the patient remained in pain. It was therefore decided to start treatment with teriparatide in order to augment bone healing. Two months after teriparatide treatment was started, the patient was in significantly less pain. Cervical spine CT showed a clear bone consolidation, and 12 months later patient remains in the same clinical situation.