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

Abstract

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.

Biomechanical influence of the surgical approaches, implant length and density in stabilizing ankylosing spondylitis cervical spine fracture

“…Combined surgery can provide strong internal fixation, which allows patients to exercise early for functional recovery and thus reduces the incidence of pulmonary infection associated with long-term bed rest. Although combined approaches are the most invasive option, in cases of ASCF, many studies have shown strong support for this type of treatment [28][29][30][31][32] . This FEM study also found that the combined anterior and posterior approach has the minimal RoM change at the fractured level (C5/6) and the smallest implant MS compared with either approach alone; even 1-level combined fixation provides better stability than 5-level posterior-alone fixation.…”

“…Surgical approaches for ASCF include anterior spinal fusion (ASF) 23 , 24 , posterior spinal fusion (PSF) 11 , 25 – 27 , and anterior–posterior spinal fusion (APSF) 28 – 32 , each of which achieves partial therapeutic success. However, a consensus regarding the surgical approach and implant length and density has not been achieved, as the present available literature mainly consists of low-level evidence case series or case reports with small samples 23 , 27 , 30 .…”

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

“…IAPs of lumbar vertebrae are located on the anterior and lateral convex. They cover their anterolateral surface, which possesses inferior articular facets [19]. Thus, we hypothesized that the hypertrophy of IAP might have a close relation to facet joint arthritis and CLSS.…”

“…Our interpretation of such an association is based on our understanding that the IAP hypertrophy process begins with mechanical friction during lumbar rotation, extension, and flexion. Because the inferior articular facet meets the superior articular facet at the posterior and medial concavity of the adjoining surface [19], these frictions can exert continuous pressure on zygapophyseal joints and alter morphological features of IAP, leading to a high degree of abrasion [20]. Burke et al have reported a case of spinal cord trauma caused by direct transmission of force from an ostectomy to a symptomatic ossified ligamentum flavum during resection of an IAP [21].…”

Ураження Нервової Системи При Анкілозуючому Спондиліті, Що Почався В Дитячому Та Дорослому Віці

“…Распространенность анкилозирующего спондилита (АС) среди населения достигает 0,3 % [10, 13], а одним из наиболее частых проявлений заболевания является поражение центральной (ЦНС) и периферической нервной системы (ПНС) [9,11], что в первую очередь обусловлено патологией позвоночника [8]. К главным причинам тяжелой нейропатии у больных АС относятся подвывихи и микропереломы позвонков [6,7,16], а также демиелинизирующая патология [4]. Необходимо отметить, что для таких пациентов свойственны нарушения вегетативного звена нервной системы [14], которые прежде всего затрагивают ее парасимпатическую составляющую [12].…”