Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this study was to describe a single surgeon's experience managing craniovertebral junction (CVJ) disease due to ankylosing spondylitis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors undertook a retrospective review of the records of patients with CVJ disease due to ankylosing spondylitis who were evaluated and treated by the senior author. Charts were reviewed for symptoms and signs at presentation, radiography results, treatment, and outcome. In addition, some of the patients had pathology reports available for review.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eight patients with CVJ disease due to ankylosing spondylitis were identified who were evaluated by the senior author in the years 1990–2008. The most common presenting symptoms were neck pain (37.5%), cranial neuropathy (37.5%), and sensory disturbance (62.5%). On examination, the most common findings were limited cervical range of motion (37.5%), weakness (50%), and myelopathy (75%). Radiographic evaluation revealed atlantoaxial subluxation, retroodontoid pannus formation, basilar invagination, and bone erosion. Surgery was offered to all of the patients, 7 of whom underwent operations. In most cases, the treatment was transoral–transpalatopharyngeal decompression followed by occipitocervical fusion. One patient with a reducible lesion underwent dorsal fusion alone. Neurological outcomes were favorable overall.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The incidence of CVJ disease in patients with ankylosing spondylitis varies among reports. These cases are rare in most neurosurgery clinics. It is important to recognize that patients with ankylosing spondylitis are at risk for CVJ disease, similar to patients with rheumatoid arthritis. Principles common to the management of other CVJ pathologies apply to these patients as well.</jats:p></jats:sec>

Extensive ossification of the paraspinal ligaments in a patient with vitamin D-resistant rickets: Case report with literature review

“…Given the preserved but minor mobility at the craniovertebral junction, continuing mechanical stress may have been imposed on the stenotic lesion, leading to myelopathy. Similar pathomechanisms have been reported in patients with ankylosing spondylitis, presenting as various pathologies at the craniovertebral junction including atlantoaxial subluxation, retroodontoid pannus, basilar invagination, and bone erosion [20].…”

Abdominal changes in patients with degenerative spinal deformity

“…On the one hand, unlike AS, degenerative TLK only exist in thoracolumbar segment, and have limited impact on longitudinal diameter (a), and DK on the other hand has a greater range of motion and less degree of deformity than AS, body can compensate for this change to some extent through the thoracic vertebrae and pelvis. [ 17 ] It is worthy of attention that the reduction of abdominal volume caused by degenerative scoliosis is mainly due to the decrease of the anterior-posterior diameter of the abdominal cavity, which may be caused by the rotation of the vertebral body caused by scoliosis deformity. Liljenqvist et al [ 18 ] found that the rotation of the vertebral body can cause the posterior peritoneum to move to the ventral side.…”

Lesion of the craniovertebral junction in ankylosing spondylitis: rare clinical observations

“…При болезни Бехтерева хроническое воспаление, поражающее суставы и связки, приводит к оссификации и анкилозированию позвоночника. Закономерным исходом заболевания является утрата мобильности и формирование кифотической деформации позвоночника [2].…”

“…Самая большая серия наблюдений, представленная в современной литературе, составила 8 пациентов, оперированных в 1990-2008 гг. [2]. Как и при ревматоидном артрите, для анкилозирующего спондилоартрита краниовертебральной области характерно формирование дислокаций и воспалительных изменений, приводящих В результате вмешательства устранена компрессия спинного и продолговатого мозга, достигнута стабильная фиксация краниовертебральной области (рис.…”

“…Помимо специфических признаков патологии позвоночного столба, при рентгенологическом и томографическом исследованиях выявлены более выраженное разрушение боковых атлантоаксиальных суставов, эрозия и деструкция зубовидного отростка, а также гетеротопическая оссификация связочного аппарата. Ответить на вопрос, была ли ассимиляция атланта в первом клиническом наблюдении самостоятельной нозологией или следствием конкресценции боковых масс атланта с мыщелками затылочной кости на фоне анкилозирующего спондилоартрита, не представляется возможным, хотя в литературе имеются сообщения о приобретенном характере этих изменений [2,6]. Таким образом, можно предположить, что причиной формирования воспалительной гранулемы была стрессовая нагрузка на наиболее подвижное атлантоаксиальное сочленение вследствие утраты мобильности субаксиальных сегментов позвоночного столба.…”