{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:24:28Z","timestamp":1770114268838,"version":"3.49.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"\n BACKGROUND<\/jats:title>\n Ankylosing spondylitis (AS) is a chronic inflammatory disease marked by spinal rigidity, which predisposes patients to unstable fractures even after minor trauma. While isolated spinal fractures in AS are well described, multilevel fractures across the cervical, thoracic, and lumbar spine following a single traumatic event are exceedingly rare and pose substantial diagnostic and surgical challenges.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 41-year-old male with advanced AS and a history of alcohol use and diabetes who sustained six unstable spinal fractures spanning the cervical, thoracic, and lumbar regions after a motor vehicle accident. The surgical intervention involved staged posterior spinal fusion (C3\u2013T7, L2\u2013S2 with pelvic extension), open reduction and internal fixation (C6\u20137, T2\u20133, L4), and laminectomy (T2\u20133). Neuronavigation and intraoperative fluoroscopy guided precise instrumentation. The patient had no postoperative neurological deficits and was discharged with a comprehensive postoperative care plan, including physical therapy and follow-up imaging.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case underscores the importance of high clinical suspicion and early imaging in AS patients with trauma, given their high risk for occult spinal fractures. Posterior-only surgical approaches can provide effective stabilization in complex multilevel injuries, especially in patients with comorbidities that preclude anterior exposure.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25236<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25236","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T02:53:14Z","timestamp":1751856794000},"source":"Crossref","is-referenced-by-count":0,"title":["Multilevel spinal fractures in ankylosing spondylitis: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Matthew A.","family":"Abikenari","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay S.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5516-9431","authenticated-orcid":true,"given":"Kelly H.","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ummey","family":"Hani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2648-4894","authenticated-orcid":true,"given":"Bhav","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anand","family":"Veeravagu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"9570","key":"bib1","series-title":"Lancet","first-page":"1379","article-title":"Ankylosing spondylitis","volume":"369","author":"Braun","year":"2007","unstructured":"Braun JSieper J.Ankylosing spondylitis. 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BMJ Case Rep. 2019;12(8):e230113."},{"issue":"4","key":"bib4","series-title":"J Rheum Dis","first-page":"193","article-title":"The epidemiology and treatment of ankylosing spondylitis in Korea","volume":"29","author":"Kwon","year":"2022","unstructured":"Kwon SRKim THKim TJPark WShim SC.The epidemiology and treatment of ankylosing spondylitis in Korea. J Rheum Dis. 2022;29(4):193-199."},{"issue":"11","key":"bib5","series-title":"J Rheumatol","first-page":"1629","article-title":"The risk and consequences of vertebral fracture in patients with ankylosing spondylitis: a population-based data linkage study","volume":"47","author":"Ognjenovic","year":"2020","unstructured":"Ognjenovic MRaymond WDInderjeeth CAKeen HIPreen DBNossent JC.The risk and consequences of vertebral fracture in patients with ankylosing spondylitis: a population-based data linkage study. 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J Rheum Dis. 2022;29(4):193-199."},{"issue":"11","key":"bib5","series-title":"J Rheumatol","first-page":"1629","article-title":"The risk and consequences of vertebral fracture in patients with ankylosing spondylitis: a population-based data linkage study","volume":"47","author":"Ognjenovic","year":"2020","unstructured":"Ognjenovic MRaymond WDInderjeeth CAKeen HIPreen DBNossent JC.The risk and consequences of vertebral fracture in patients with ankylosing spondylitis: a population-based data linkage study. J Rheumatol. 2020;47(11):1629-1636."},{"issue":"12","key":"bib6","series-title":"Clin Rheumatol","first-page":"4915","article-title":"Investigating diagnosis, treatment, and burden of disease in patients with ankylosing spondylitis in Central Eastern Europe and the United States: a real-world study","volume":"40","author":"Korotaeva","year":"2021","unstructured":"Korotaeva TDina OHoldsworth EInvestigating diagnosis, treatment, and burden of disease in patients with ankylosing spondylitis in Central Eastern Europe and the United States: a real-world study. Clin Rheumatol. 2021;40(12):4915-4926."},{"issue":"13","key":"bib7","series-title":"J Gen Intern Med","first-page":"3283","article-title":"Ankylosing spondylitis and the risk of hip fractures: a matched cohort study","volume":"37","author":"Tsur","year":"2022","unstructured":"Tsur AMDavid PWatad ANissan DCohen ADAmital H.Ankylosing spondylitis and the risk of hip fractures: a matched cohort study. J Gen Intern Med. 2022;37(13):3283-3288."},{"issue":"3","key":"bib8","series-title":"Best Pract Res Clin Rheumatol","first-page":"101871","article-title":"Challenges in the diagnosis of axial spondyloarthritis","volume":"37","author":"van Gaalen","year":"2023","unstructured":"van Gaalen FARudwaleit M.Challenges in the diagnosis of axial spondyloarthritis. Best Pract Res Clin Rheumatol. 2023;37(3):101871."},{"issue":"4","key":"bib9","series-title":"Neurospine","first-page":"786","article-title":"Spinal fractures in ankylosing spondylitis: patterns, management, and complications in the United States\u2014analysis of latest nationwide inpatient sample data","volume":"18","author":"Kandregula","year":"2021","unstructured":"Kandregula SBirk HSSavardekar ASpinal fractures in ankylosing spondylitis: patterns, management, and complications in the United States\u2014analysis of latest nationwide inpatient sample data. 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Eur Spine J. 2009;18(2):145-156."},{"issue":"10","key":"bib12","series-title":"J Rheumatol","first-page":"1981","article-title":"Clinical vertebral fractures in patients with ankylosing spondylitis","volume":"31","author":"Vosse","year":"2004","unstructured":"Vosse DFeldtkeller EErlendsson JGeusens Pvan der Linden S.Clinical vertebral fractures in patients with ankylosing spondylitis. J Rheumatol. 2004;31(10):1981-1985."},{"issue":"1","key":"bib13","series-title":"Eur Spine J","first-page":"51","article-title":"Spinal fractures in patients with ankylosing spondylitis","volume":"5","author":"Olerud","year":"1996","unstructured":"Olerud CFrost ABring J.Spinal fractures in patients with ankylosing spondylitis. 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Clin Spine Surg. 2023;36(1):8-14."},{"issue":"1","key":"bib16","series-title":"BMC Musculoskelet Disord","first-page":"370","article-title":"A posterior-only approach for ankylosing spondylitis (AS) with thoracolumbar pseudoarthrosis: a clinical retrospective study","volume":"21","author":"Kou","year":"2020","unstructured":"Kou JGuo JJi XA posterior-only approach for ankylosing spondylitis (AS) with thoracolumbar pseudoarthrosis: a clinical retrospective study. BMC Musculoskelet Disord. 2020;21(1):370."},{"issue":"1","key":"bib17","series-title":"J Orthop Surg Res","first-page":"136","article-title":"Treatment of kyphosis in ankylosing spondylitis by osteotomy through the gap of a pathological fracture: a retrospective study","volume":"11","author":"Zhang","year":"2016","unstructured":"Zhang HZhou ZGuo CWang YYu HWang L.Treatment of kyphosis in ankylosing spondylitis by osteotomy through the gap of a pathological fracture: a retrospective study. 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