Iatrogenic paraplegia in 2 morbidly obese patients with ankylosing spondylitis undergoing total hip arthroplasty
Report of 2 cases
Shabbar F. Danish, M.D., Jessica A. Wilden, M.D., and James Schuster, M.D., Ph.D.
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
Abbreviations used in this paper: AS = ankylosing spondylitis; CT = computed tomography; MR = magnetic resonance; THA = total hip arthroplasty; VB = vertebral body.
Address correspondence to: James Schuster, M.D., Ph.D., Department of Neurosurgery, Silverstein Building, Floor 3, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. email:
james.schuster@uphs.upenn.edu.
DOI: 10.3171/SPI-08/01/080
The authors describe 2 cases of intraoperative thoracic vertebral body extension fractures in morbidly obese patients with ankylosing spondylitis (AS), undergoing total hip arthroplasty, with resultant acute traumatic paraplegia. The pathophysiology with regard to the surgical positioning and the associated risks of obesity and AS are reviewed. Additionally, strategies for avoiding these types of injuries are discussed.
Keywords: ankylosing spondylitis; fracture; spine.
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