Cervical spinal cord injury complicating ankylosing spondylitis

Abstract

SummaryWithin a period of 12 years 466 patients with acute spinal cord injury were admitted to our Centre, seven of these having ankylosing spondylitis (AS), A history of alcohol consumption preceding the accident was present in five patients, and in four there was a history of neurological deterioration before their admission. An epidural hematoma was found in one patient and four expired within 3 months of their injury,The incidence of ankylosing spondylitis in cervical cord injury was 1.5°,,, and an associated epidural hematoma was present in some 14% of the patients, The mortality rate was 57%, There was a high incidence of alcoholic use before the accident. Neurological deterioration commonly occurred before admission,

Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance

“…A higher incidence of cervical SCI has also been noted in the population with AS, accounting for up to 84% of all cord injuries, 1 in comparison to a 55% incidence of cervical SCI in the general spinal cord-injured population. 36 The incidence of complete SCI also appears to be higher in patients with AS 1,12,19,30,39 than in the general population. Patients with AS who sustain an SCI are older than the general spinal cord-injured population, with a mean age from 55 to 61 years in various series 1,5,34,39 compared with a mean age of 37 in the spinal cord-injured population at large.…”

“…Hyperextension was the most frequently observed mechanism of injury in a series of AS-related vertebral fractures, 1,19,20,30,39 although the author of one series noted that flexion mechanisms predominated in a cohort. 34 The prevalence of hyperextension injuries likely reflects the vulnerability of patients with AS to falls because of progressive kyphotic angulation and an inability to properly visualize the ground ahead while walking.…”

“…The mortality rates for patients with AS and SCI range from 35 to 50% in various series, 19,30,34,39 compared with rates of 4-16% for the general population of spinal cordinjured patients.…”

“…15 Spinal epidural hematoma occurs due to bleeding from the epidural venous plexus and/or diploë of the pathological bone. Posttraumatic spinal epidural hematoma occurs with an incidence of 10-50% 19,20,34 and often has devastating neurological consequences if not recognized and treated emergently.…”

Cervical spinal cord injury in sapho syndrome

“…9 Bohlman and Foo estimated the incidence of AS in SCI between 1.5 and 3%. 10,11 Ossi®ed ligaments, loss of elasticity and osteopenia result in a rigid, brittle structure that is much more prone to fracture resulting from minor trauma. 12 Such fractures present a high rate of severe neurological de®cit and a major risk of epidural hematoma and pseudarthrosis.…”