Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

Heyde, Christoph‐E.; Fakler, Johannes K. M.; Hasenboehler, Erik A.; Stahel, Philip F.; John, Thilo; Robinson, Yohan; Tschoeke, Sven K.; Kayser, R.

doi:10.1186/1754-9493-2-15

Cited by 33 publications

(37 citation statements)

References 41 publications

(211 reference statements)

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“…The single anterior approach has certain advantages such as less trauma, complete decompression of the anterior column, and a higher fusion rate of the anterior column; many successful cases have been reported [12]. However, in terms of patients with severe fracture displacements, some researchers believe that there may be a risk of plate and screw loosening [13].…”

Section: Discussionmentioning

confidence: 99%

Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

Yang

Teng

2017

BioMed Research International

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For patients with AS and lower cervical spine fractures, surgical methods have mainly included the single anterior approach, single posterior approach, and combined anterior-posterior approach. However, various surgical procedures were utilized because the fractures have not been clearly classified according to presence of displacement in these previous studies. Consequently, controversies have been raised regarding the selection of the surgical procedure. This study retrospective analysis was conducted in 12 patients with AS and lower cervical spine fractures and dislocations and explored single-session combined anterior-posterior approach for the treatment of AS with obvious displaced lower cervical spine fractures and dislocations which has demonstrated advantages such as good stabilization, satisfied fracture healing, and easy postoperative cares. However, to some extent, the difficulty and risk of this approach should be considered. Attention should be paid to the prevention of perioperative complications.

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Section: Discussionmentioning

confidence: 99%

Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

Yang

Teng

2017

BioMed Research International

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“…In the last years there has been a positive trend towards the use of computed tomography instead of conventional radiographs especially in patients with AS [7]. A decreased number of missed fractures could explain the relative increase in thoracic fractures, which can be hard to visualise on plain radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…If not adequately stabilised, these patients may experience pseudarthrosis, implant failure, and secondary dislocation [7]. Medical treatment of AS improved dramatically during the last decades.…”

Section: Introductionmentioning

confidence: 99%

Increased occurrence of spinal fractures related to ankylosing spondylitis: a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden

2013

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BackgroundAnkylosing spondylitis (AS) is a rheumatoid disease leading to progressive ossification of the spinal column. Patients suffering from AS are highly susceptible to unstable vertebral fractures and often require surgical stabilisation due to long lever arms. Medical treatment of these patients improved during the last decades, but until now it is unknown whether the annual number of spinal fractures changed during the last years. Since the annual count of fracture is an effective measure for efficacy of injury prevention and patient safety in AS patients, the current recommendations of activity have to be revised accordingly.MethodsData for all patients with AS treated as inpatients between 01/01/1987 and 31/12/2008 were extracted from the Swedish National Hospital Discharge Registry (SNHDR). The data in the registry are collected prospectively, recording all inpatient admissions throughout Sweden. The SNHDR uses the codes for diagnoses at discharge according to the Swedish versions of the International Classification of Diseases (ICD-9 and ICD-10).ResultsDuring the years from 1987 to 2008 17,764 patients with AS were treated as inpatients; of these 724 patients were treated due to spinal fractures. The annual number of cervical, thoracic and lumbar fractures in the registry increased until 2008 (r = 0.94).ConclusionsDespite the improved treatment of AS the annual number of vertebral fractures requiring inpatient care increased during the last two decades. Possible explanations are population growth, greater awareness of fractures, improved diagnostics, improved emergency care reducing fatalities, and a higher activity level of patients receiving modern medical therapy. Obviously the improvement of medical treatment did not reduce the susceptibility of these patients to unstable fractures. Thus the restrictive injury prevention recommendations for patients with AS cannot be defused, but must be critically revised to improve patient safety.

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“…In such conditions, early diagnosis of spinal fracture in ankylosed spine seemed to be relatively difficult. As reviewed by Heyde et al, beause of pathological tension and shearing force with lacking flexibility due to kyphosis and spinal rigidity, spinal fracture may occur even after minor trauma in ankylosed spine [14]. Secondery osteoporosis and loss of muscle strength also cause the fragility of the spine [14].…”

Section: Discussionmentioning

confidence: 99%

Pathologic thoracic spine fracture in presence of Parkinson’s disease and diffuse ankylosis: successful management of a challenging condition

Aoki

Nakajima

Sakakibara

et al. 2013

BMC Musculoskelet Disord

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BackgroundPatients with Parkinson’s disease have higher risk of complications and revision surgery following spine surgery. Spinal fracture in an ankylosed spine is also difficult to treat. We recently treated a case of thoracic spine fracture in a patient with Parkinson’s disease complicating a severely ankylosed spine. There is no report describing surgical treatment of spine fracture in such a difficult condition, thus, we firstly report the case and discuss the reasons for a successful result.Case presentationsA 68-year-old man with Parkinson’s disease had a pathologic thoracic spine fracture at T11. Four days after onset, he was referred to a local hospital because of gradually increasing back pain, but no spinal fracture was pointed out at that time. Because he developed lower extremity bilateral numbness and weakness, he was transported to our hospital, eight days after onset. When referred to our hospital, he exhibited severe back pain and paralysis of the lower extremities due to spinal cord involvement. Emergency surgery was performed. Decompression of T10-11 was performed followed by instrumented spinal fusion from T8 to L2. A dramatic neurological improvement was observed following surgery, and complete bony fusion was achieved. At the final two-year postoperative follow-up, the patient had no pathological symptoms related to spinal fracture and no instrument failure was observed.ConclusionThis patient had Parkinson’s disease and a severely ankylosed spine, both of which may lead to unsatisfactory surgical results from spinal surgery. Generally, patients with Parkinson’s disease have an increased risk for adjacent segment disease and instrument failure. In this patient, fusion surgery did not change the number of fused segments because operated segments were already ankylosed. Because no stress force exists between adjacent vertebral bodies, a severely ankylosed spine may help prevent screw pullout. Thus, treatment of a spinal fracture in an ankylosed spinal segment is a less adverse condition for patients with Parkinson’s disease. Our experience led us to think that a combination of Parkinson’s disease with severely ankylosed spine does not necessarily suggest unsatisfactory outcomes after surgical treatment of spinal fracture.

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Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

Cited by 33 publications

References 41 publications

Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

Increased occurrence of spinal fractures related to ankylosing spondylitis: a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden

Pathologic thoracic spine fracture in presence of Parkinson’s disease and diffuse ankylosis: successful management of a challenging condition

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