Epidural hematoma in patients with ankylosing spondylitis requiring surgical stabilization: a single-institution retrospective review with literature analysis

Abstract

OBJECTIVE Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen–B27. There appears to be an increased frequency of associated epidural hematomas in spine fractures in patients with AS. The objective was to review the incidence within the literature and a single-institution experience of the occurrence of epidural hematoma in the context of patients with AS requiring spine surgery. METHODS Deep 6 AI software was used to search the entire database of patients at a single level I trauma center (since the advent of the institution’s modern electronic health record system) to look at all patients with AS who underwent spinal surgery and who had a diagnosis of epidural hematoma. Additionally, a systemic literature review was performed of all papers evaluating the incidence of epidural hematoma in patients with spine fractures. RESULTS A single-institution, retrospective review of records from 2009 to 2020 yielded a total of 164 patients with AS who underwent spine surgery. Of those patients, 17 (10.4%) had epidural hematomas on imaging, with the majority requiring surgical decompression. These spine fractures occurred close to the cervicothoracic or thoracolumbar junction. The patients ranged in age from 51 to 88 years, and there were 14 males and 3 females in the cohort. Eight patients were administered an antiplatelet and/or anticoagulant agent, and the rest were not. All patients required surgical stabilization, with 64.7% of patients also requiring decompressive laminectomies for evacuation of the hematoma and spinal cord decompression. Only 1 death was reported in the series. There was a tendency toward neurological improvement after surgical intervention. CONCLUSIONS AS has been a well-described pathologic process that leads to an increased risk of three-column injury in spine fracture, with an increased incidence of symptomatic epidural hematoma compared with patients without AS. Early recognition of this entity is important to ensure that appropriate surgical management includes addressing compression of the neural elements in addition to surgical stabilization.

Screw fixation without fusion for low lumbar chance fracture accompanied by spinal epidural hematoma in patient with ankylosing spondylitis

“…The iliolumbar ligaments and their location below the pelvic brim are two stabilizing factors that are unique to these fractures compared with those of the cervical, cervicothoracic, or thoracolumbar junction. The incidence of SEH is higher in patients with AS than in healthy people [ 5 , 6 ]. It is reasonable to assume that when SEH is associated with a vertebral fracture, bleeding could originate in the fractured spongy bone or from the damaged venous plexus of the epidural space with a secondary collection of blood.…”

Surgical treatment of thoracolumbar fracture in ankylosing spondylitis: A comparison of percutaneous and open techniques

“…Fractures are usually associated with low-energy trauma [15]. Heterotopic bone fracture may be due to hematoma or oppressive nerve block in different degrees of neurological symptoms [16][17][18]. For patients with unstable spine fracture and spinal cord injury or hematoma AS patients, surgery is often recommended.…”

Spontaneous Cervical Epidural Hematoma Following Anti-Coagulant Medications with Quadriparesis: A Case Report and Narrative Review

“…All required surger y, 64.7% required decompressive procedures in addition to fixation of fracture and most improved neurologically after intervention. Thus, in a traumatic ankylosing spondylitis case with deteriorating neurology, having a differential diagnosis of epidural hematoma is important [14]. Liao et.al used modified Rankin Scale (mRS) to record functional recovery following SSEH (Table 3).…”