Cervical fractures in conjunction with spondylitis ankylosans

Abstract

In addition to general kyphoscoliosis, grotesque inclination and false positioning of the head are additional characteristics of Bekhterev's spondylitis. The causes of these changes are often fractures and are seldom of rheumatic nature. Although accidents can cause severe instability in the whole, stiffened vertebral column, minor trauma are not usually recognised. Even slight sintered fractures of the ventral vertebral area usually have a dorsal distraction component and can later increase to full dislocation. Severe deformation, which alone indicates the degree of damage, may not taken seriously until neurological changes occur. A definitive differentiation from an Anderson lesion is difficult, although this is of no relevance to the operative-therapeutic methods used. The earliest possible recognition of such a fracture or instability is of greatest prognostic significance to correct the situation without great difficulty, if necessary by using a Crutchfield clamp or a halo vest. If the fracture is found too late, such easy methods of correction are no longer possible and a more complex procedure is necessary. Whereas satisfactory stability can already be achieved via ventral access in the case of complete repositioning of the fracture, in the case of severe kyphosis and rigidity a combined dorsoventral approach involving several operations is necessary and the risk of complications is much higher.

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

“…If there is sufficient TCL and lordosis at fusion block with an anteriorly located stenosis accomponying the ADD, the authors currently recommend implant removal and ACDF at the involved segment. In case of ADD particularly at the CTJ, 360°stabilization should be considered to prevent construct failure due to the long lever-arm resulting from the preexisting cephalad fusion block [60,62,74].…”

Surgical management of cervical fractures in ankylosing spondylitis using a combined posterior-anterior approach

“…5,9,10 Surgical management most commonly consists of a long posterior fixation/ fusion, sometimes in combination with anterior fixation, whereas a primary anterior approach is rarely recommended. 5,9,10,12 A purely posterior fixation/fusion seems only indicated if the anterior weight-bearing column is well aligned and without fracture gaps. 10 Furthermore, posterior fixation alone may have to be supplemented with postoperative halo immobilisation.…”

“…[16][17][18][19][20][21] Poor bone quality, vulnerable skin, and difficulty in achieving good alignment are additional arguments against the use of a halo. 12 In order to avoid the frequently observed secondary neurological complications after conservative treatment, others recommend surgical fixation. 5,9,10 Surgical management most commonly consists of a long posterior fixation/ fusion, sometimes in combination with anterior fixation, whereas a primary anterior approach is rarely recommended.…”

“…8,9 Therapeutic management of cervical fractures in ankylosing spondylitis is controversial: proponents of conservative management claim a high mortality after surgery, 8,11 whereas others suggest that surgical fixation can be used to overcome the complications of conservative treatment, especially secondary loss of correction with neurological worsening and pin site infection with halo immobilisation. 5,9,10,12 Four consecutive ankylosing spondylitis patients have been admitted to our institution with a cervical fracture over the past 2 years. All four patients were treated with a combined posterior-anterior correction and fixation/ fusion.…”

Das besondere Instrument Der Halo-Fixateur

“…Ein Anwendungsschwerpunkt besteht aktuell bei der Korrektur von Wirbelsäulendeformitäten, besonders bei zweizeitigem Vorgehen nach vorgeschaltetem Release oder mobilisierender Osteotomie [16]. In diesem Anwendungsfall wird die Halo-Extensionstechnik meist in Form einer Extension an einem Rollstuhl genutzt (s. Abbildungen 7a und 7b).…”