Comparison of Surgical Outcomes of the Posterior and Combined Approaches for Repair of Cervical Fractures in Ankylosing Spondylitis

Abstract

Study Design Retrospective cohort study. Purpose To evaluate surgical outcomes and complications of cervical spine fractures in ankylosing spondylitis (CAS) patients who were treated using either the posterior (P) or combined approach (C). Overview of Literature Ankylosing spondylitis typically causes progressive spinal stiffness that makes patients susceptible to spinal fractures. CAS is a highly unstable condition. There is contradictory evidence regarding which treatment option, the posterior or the combined approach, yields superior clinical results. Methods A single institution database was reviewed for data in the period 1999 to 2015. All CAS patients who underwent posterior or combined instrumented fusion were enrolled. We analyzed demographic data, radiographic results, perioperative complications, and postoperative results. Results Thirty-three patients were enrolled (23 in the P group, 10 in the C group). All patients presented with neck pain after a fall. In the P group, mean operative time was 161.1 minutes (100–327 minutes), and mean estimated blood loss (EBL) was 306.4 mL (50–750 mL). In the C group, 90% of patients underwent a staged procedure, typically with posterior surgery first. Mean EBL was 124 mL (25–337 mL). For posterior surgery, mean EBL was 458.3 mL (400–550 mL). EBL of posterior surgery in the C group was higher but this difference was not significant ( p =0.16). Postoperative complication rate was higher in the C group but this difference was not significant (50% vs. 17.4%, p =0.09). In the follow-up period, no late reoperations were performed. Patients who underwent C surgery had a higher rate of neurological improvement but this difference was not significant ( p =0.57). Conclusions Both P and C provided good clinical results. P surgery had lower EBL, lower postoperative complication rate, and shorter length of stay than C surgery; none of these differences were statistically significant.

Fracturas de la columna vertebral en pacientes con espondilitis anquilosante

“…4 La posibilidad de sufrir una fractura por un traumatismo de baja energía es alta 16 y la hiperextensión es el mecanismo de lesión más frecuente. 15 La rigidez espinal y la baja densidad mineral ósea son las causas intrínsecas que favorecen la lesión. Los factores de riesgo mecánicos, como la fusión espinal, la disminución de la movilidad de la columna vertebral y la presencia de sindesmofitos, predisponen a sufrir fracturas vertebrales.…”

“…compararon los resultados quirúrgicos del abordaje posterior y los abordajes combinados para la reparación de fracturas cervicales en pacientes con EA y comunicaron que tanto el abordaje posterior como los abordajes combinados obtuvieron buenos resultados, incluida la mejoría del estado neurológico sin la necesidad de reoperación. 15 Longo y cols., 27 en una revisión sistemática de 2015, mostraron que las fracturas cervicales eran más comunes en los hombres (94%) y que típicamente ocurrían en pacientes de mediana edad (media de la edad 59.2 años). Los niveles afectados fueron C6-7, C5-6 y C4-5.…”

“…13,14 El tratamiento conservador se ha correlacionado con una tasa de mortalidad alta; 13 por lo tanto, actualmente, el manejo quirúrgico de estas enfermedades es de elección, incluidas la descompresión, la reducción de los trazos fracturarios y la fusión instrumentada. 15 Se presenta una serie de casos con el objetivo de evaluar la cinemática, considerar las dificultades diagnósticas, describir las lesiones y las posibilidades terapéuticas, analizar la presentación de complicaciones y realizar una actualización bibliográfica.…”

Surgical Stabilization of a Cervical Fracture in a Patient with Ankylosing Spondylitis in the Sitting Position

“…Surgical interventions employ either a posterior or combined approach. Both approaches lead to similar outcomes and improved outcomes and lower complication rates and failure than an anterior approach [17,18]. A posterior approach, indicated if the anterior weight-bearing column is aligned properly and lacks fracture gaps, commonly involves either posterior fixation with screws and plates or rods or the addition of a posterior bone graft [9,19].…”

Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

“…A total of 299 papers were obtained from the preliminary search, 201 duplicate published papers were eliminated by NoteExpress software (Version 3.3) software, and 68 papers that did not meet the inclusion criteria were screened by reading the title and abstract content,19 papers were excluded by a careful reading of the full text of the remaining 30 papers, and 11 papers [9][10][11][12][13][14][15][16][17][18][19] were finally included in this study. The screening process is shown in Figure 1.…”