Fracture of the lower cervical spine in patients with ankylosing spondylitis: Retrospective study of 19 cases

Kouyoumdjïan, Pascal; Guérin, Patrick M.; Schaelderle, C.; Asencio, G.; Gille, Olivier

doi:10.1016/j.otsr.2012.03.011

Cited by 47 publications

(63 citation statements)

References 47 publications

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“…• Hyperextension is the most frequently observed mechanism of injury [2,43]. • The lower cervical spine is the most commonly injured area because of its increased mobility, small vertebral bodies, oblique articular facets, and the mobility of the skull on it [2,3,67]. (Fig.…”

Section: • the Majority Of Fractures Occur After Low-energy Traumamentioning

confidence: 99%

“…1) or through the intervertebral disk (transdiskal fractures) (Fig. 2), because of extensive osteopenic changes and loss of elasticity of the disks [2,7,8,43,66,67]. The most common path of these AS-related vertebral fractures is through the disk space, which represents the weakest point in the ankylosed spine, because of chondroid metaplasia and calcification of the annulus fibrosus and nucleus pulposus [2,68].…”

Section: • the Majority Of Fractures Occur After Low-energy Traumamentioning

confidence: 99%

“…Management of spinal fractures in patients with AS is controversial [67], and no treatment guidelines are available for a and b). Note a heterogeneous dorsally located epidural collection extending from L1 to L5, which represents a spinal epidural hematoma (small arrows in b).…”

Section: Treatmentmentioning

confidence: 99%

“…Spinal epidural hematomas may occur in as many as 10 % of patients [74,77], and its formation should be excluded by means of MR imaging [40,78]. There is some controversy regarding the best way of managing a spinal epidural hematoma, some authors [79,80] describing good outcome following both surgical and conservative management and others [81] reporting a low neurological recovery rate if not evacuated within 36 h. In ankylosed spinal fractures, non-operative treatment has long been the reference standard [45,[82][83][84][85][86] and generally consists of bed rest, skeletal traction, and bracing or immobilization with halo-vest [67]. Effectively, non-displaced or minimally displaced acute traumatic lesions may be treated by conservative methods [45,87], but the inherent instability of these fractures, reflected by their high potential of acute displacement, may cause a catastrophic situation [44].…”

Section: Treatmentmentioning

confidence: 99%

“…Therefore, surgical fixation with long segmental instrumentation and fusion is highly recommended [44]. Previous studies [67,81,90] have demonstrated a trend for higher complication rates in non-operative patients, as bed rest is associated with pulmonary complications [67], axial traction can be at the origin of serious medullary distractions [81], and use of a halo represents a secondary source of aggravation [56,85]. Furthermore, conservative treatment has been associated with poor results such as worsening of the regional deformity with loss of reduction, risk of nonunion [67,[91][92][93], and risk of neurological aggravation [1,2,67,90].…”

Section: Treatmentmentioning

confidence: 99%

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Spinal fractures in patients with ankylosing spondylitis

Leone¹,

Marino²,

Dell'atti³

et al. 2016

Rheumatol Int

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The ankylosed spine is prone to fracture even after minor trauma due to its changed biomechanical properties. The two central features of ankylosing spondylitis (AS) that promote the pathological remodeling of the spine are inflammation and new bone formation. AS is also associated with osteoporosis that is attributed to an uncoupling of the bone formation and bone resorption processes. Therefore, bone resorption occurs and promotes weakening of the spine as well as increased risk of vertebral fractures which can be hugely different in terms of clinical relevance. Even in the presence of symptomatic clinical vertebral fractures, the diagnosis can be overruled by attributing the pain to disease activity. Furthermore, given the highly abnormal structure of the spine, vertebral fracture diagnosis can be difficult on the basis of radiography alone. CT can show the fractures in detail. Magnetic resonance imaging is considered the method of choice for the imaging of spinal cord injuries, and a reasonable option for exclusion of occult fractures undetected by CT. Since it is equally important for radiologists and clinicians to have a common knowledge base rather than a compartmentalized view, the aim of this review article was to provide the required clinical knowledge that radiologists need to know and the relevant radiological semiotics that clinicians require in diagnosing clinically significant injury to the ankylosed spine.

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Section: • the Majority Of Fractures Occur After Low-energy Traumamentioning

confidence: 99%

Section: • the Majority Of Fractures Occur After Low-energy Traumamentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Spinal fractures in patients with ankylosing spondylitis

Leone¹,

Marino²,

Dell'atti³

et al. 2016

Rheumatol Int

View full text Add to dashboard Cite

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Combined anterior and posterior approach in treatment of ankylosing spondylitis-associated cervical fractures: a systematic review and meta-analysis

Chen

Zhou

et al. 2022

Eur Spine J

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Objective Cervical fractures with ankylosing spondylitis (CAS) are a specific type of spinal fracture with poor stability, low healing rate, and high disability rate. Its treatment is mainly surgical, predominantly through the anterior approach, posterior approach, and the anterior–posterior approach. Although many clinical studies have been conducted on various surgical approaches, controversy still exists concerning the choice of these surgical approaches by surgeons. The authors present here a systematic evaluation and meta-analysis exploring the utility of the anterior–posterior approach versus the anterior approach and the posterior approach. Methods After a comprehensive literature search of PubMed, Cochrane, Web of Science, and Embase databases, 12 clinical studies were included in the final qualitative analysis and 8 in the final quantitative analysis. Of these studies, 11 conducted a comparison between the anterior–posterior approach and the anterior approach and posterior approaches, while one examined only the anterior–posterior approach. Where appropriate, statistical advantage ratios and 95% confidence intervals were calculated. Results The present meta-analysis of postoperative neurological improvement showed no statistical difference in the overall neurological improvement rate between the anterior–posterior approach and anterior approach (OR 1.70, 95% CI 0.61 to 4.75; p = 0.31). However, the mean change in postoperative neurological function was lower in patients who received the anterior approach than in those who received the anterior–posterior approach (MD 0.17, 95% CI -0.02 to 0.36; p = 0.08). There was an identical trend between the anterior–posterior approach and posterior approach, with no statistically significant difference in the overall rate of neurological improvement (OR 1.37, 95% CI 0.70 to 2.56; p = 0.38). Nevertheless, the mean change in neurological function was smaller in patients receiving the anterior–posterior approach compared with the posterior approach, but there was no statistically significant difference between the two (MD 0.17, 95% CI -0.02 to 0.36; p = 0.08). Conclusions The results of this review and meta-analysis suggest that the benefits of the anterior–posterior approach are different from those of the anterior and posterior approaches in the treatment of ankylosing spondylitis-related cervical fractures. In a word, there is no significant difference between the cervical surgical approach and the neurological functional improvement. Therefore, surgeons should pay more attention to the type of cervical fracture, the displacement degree of cervical fracture, the spinal cord injury, the balance of cervical spine and other aspects to comprehensively consider the selection of appropriate surgical methods.

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