Retrospective analysis of spinal trauma in patients with ankylosing spondylitis: a descriptive study in Indian population

Abstract

Objective: This study aims to understand the demographics, mode of trauma, hospital stay, complications, neurological improvement, mortality and expenditure incurred by Indian patients with spinal trauma and ankylosing spondylitis (AS). Methods: Retrospective analysis of the patient data admitted to a tertiary referral hospital from 2008 to 2013 with the diagnosis of AS and spinal trauma was carried out. The variables studied were demographics, mode of trauma, neurological status, neurological improvement, involved vertebral level, duration of hospital stay, comorbid factors, expenditure and complications during the stay. Results: Forty-six patients with diagnosis of AS with spine trauma were admitted over the last 5 years with a total of 52 fractures. All were male patients; 58.6% had injury because of trivial trauma and 78.2% patients presented with neurological injury. C5 C6, C6 C7, C7 D1 and D12 were the most common injured level. Fractures through intervertebral disc were most common in cervical spine. Of the patients, 52.7% had shown neurological improvement of at least grade 1(AIS). Mean expenditure of patient admitted with spinal cord injury (SCI) with AS is 7957 USD (United States dollar), which is around five times the per capita income in India (as per year 2013). Conclusion: Males with AS are much more prone to spinal fractures than females and its incidence may be higher than previously reported. Domestic falls are the most common mechanism of spinal trauma in this population. High velocity injuries are associated with complete SCI. The study reinforces the need for development of subsidized spinal care services for SCI management.

Ankylosing spondylitis masquerading as generalized spasticity in a patient with spinal cord injury in neurological rehabilitation setting: A case report

“…Knowledge about fall prevention strategies may result in a substantial decline in traumatic fractures in people with AS. [ 5 ] A rational understanding of patient-specific demands, individual comorbidities, and knowledge of treatment options for the underlying conditions are helpful during the rehabilitation of SCI patients.…”

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

“…Surgical management of patients with AS who sustain spinal fractures improves survival and functional outcomes, such as alleviation of neurological function injury and breathing and eating difficulties [2,10,11]. However, surgery for spinal fractures associated with AS is complex and replete with risk due to multiple factors [4,5]. Patients with AS often have greater comorbidities, such as hyperkyphosis-related reduction in pulmonary function [12][13][14].…”

“…Spinal fractures are associated with a 20% risk of spinal cord injury, with risk greatest for cervical spine fractures [4]. Fractures often necessitate surgical intervention, but surgical planning and execution is oftentimes challenging due to instability of the fracture, spinal deformity from AS, and presence of comorbidities [3][4][5].…”

Lateral position and utility of navigation for posterior fixation of unstable cervical fracture with ankylosing spondylitis

“…Preoperative considerations often include greater medical comorbidities, such as severe hypoventilation due to hyperkyphosis. [ 6 8 9 ] Significant instability raises concerns over transfers and operative positioning. Furthermore, the patient's severe kyphosis can limit the ability to position the patient for surgical anterior and/or posterior approaches.…”