Complications of halo treatment for cervical spine injuries in patients with ankylosing spondylitis – report of three cases

Schröder, J.; Liljenqvist, U.; Greiner, C; Wassmann, H.

doi:10.1007/s00402-003-0488-x

Cited by 32 publications

(18 citation statements)

References 12 publications

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“…Patient's delay may have been caused by preexisting back pain not instantly distinguishable from fracture pain. Indeed, in some cases AS patients did not notice any symptoms as a result of fracture until abrupt neurological deterioration occurred [102,122]. This phenomenon is referred to as 'the fatal pause' because of the delayed development of neurological deficits [20].…”

Section: Discussionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

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The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.

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Section: Discussionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

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“…7 Furthermore, immobilisation in a halo has been associated with serious complications. [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.…”

Section: Discussionmentioning

confidence: 99%

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

Payer¹

2006

Journal of Clinical Neuroscience

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“…There are reports of pin protrusion through the skull with intracranial complications in patients with AS. 19 Others recommend operative fixation as treatment of choice. 17 Whereas some preserve operative treatment only when a progressive neurological deficit is present.…”

Section: Discussionmentioning

confidence: 99%

Management of cervical spine fracture in patient with advanced ankylosing spondylitis using SOMI brace

Dakhil-Jerew

Derry

2008

Injury Extra

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Complications of halo treatment for cervical spine injuries in patients with ankylosing spondylitis – report of three cases

Abstract: Halo treatment for cervical spine fracture in patients with ankylosing spondylitis is a challenging task for orthopedic surgeons and neurosurgeons.

Cited by 32 publications

References 12 publications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

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

Management of cervical spine fracture in patient with advanced ankylosing spondylitis using SOMI brace

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