A man with ankylosing spondylitis and a fall-related C6 burst fracture presents a complex challenge. See the surgical management using C2-T2 posterior instrumentation to ensure stabilization.

Published: October 23, 2025

The patient

A man in his forties with a history of epilepsy and ankylosing spondylitis presented with acute onset neck pain after he was found down on the ground next to his bed by his father. The patient is amnesic to the event.

The challenge

Anteroposterior X-ray of the lumbar spine with classic appearance of “bamboo spine” seen in ankylosing spondylitis

Sagittal CT of the cervical spine demonstrates ankylosed cervical spine with a burst fracture at C6 with resultant kyphotic deformity.

The care team

Dimitri Laurent, M.D.
Spine Surgeon and Neurosurgeon
Norton Neuroscience Institute

Tom L. Yao, M.D.
Neurosurgeon
Norton Neuroscience Institute

Christopher T. Shelburne, PA-C
Physician Assistant
Norton Neuroscience Institute

The solution

The patient was placed in a rigid cervical collar. He was urgently brought to the operating room and placed under general anesthesia. Given his unstable fracture, neuromonitoring leads were placed before moving the patient to monitor for any signs of neurologic compromise during patient positioning. He was positioned prone on the operative table, and under direct fluoroscopy his alignment was manually restored. We then placed instrumentation from C2 to T2 to fuse along the fracture segment and stabilize the spine to prevent further neurologic sequelae.

Lateral projection X-ray of the cervical spine demonstrates improved alignment and stabilization with posterior instrumentation extending from C2 to T2.

The result

The patient was able to leave the hospital a few days after surgery. He did not experience any neurologic injury from the unstable C6 burst fracture.

Treatment and results may not be representative of all similar cases.