Spinal Cord Injury in Patients With Ankylosing Spondylitis

Thumbikat, Pradeep; Hariharan, Ramaswamy; Ravichandran, G; McClelland, M R; Mathew, K M

doi:10.1097/brs.0b013e31815cddfc

Cited by 113 publications

(81 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Very few papers depicted and analyzed cohorts of patients with AS-associating spine fractures, from a single medical center or region; 17,[21][22][23] other papers were systematic literature reviews. 11,18 Most of these retrospective descriptive papers (about 98%) brought out-similarly with our study-only small series of AS subjects who suffered spine fractures: 18 patients, 24 or 12 cases 25 during a 10-year period and 12 subjects 26 in 6 years. A plausible explanation for the scarcity of the cases consists of the epidemiological pattern of AS (mentioned earlier), making it difficult to establish a consistent cohort of patients in a single medical center.…”

Section: Discussionsupporting

confidence: 74%

“…As a paradigm, most of the fractures in AS patients are caused by low-energy impacts, and the most vulnerable is the cervical segment (66.7%). 18,24,28 Even in 'usual' traumatic conditions, the cervical segment is the most exposed region of the spinal column, due to its anatomical and biomechanical particularities (increased mobility, linear or translational kinetic momentum of the skull).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

Anghelescu

Onose²,

Popescu

et al. 2016

Spinal Cord Ser Cases

View full text Add to dashboard Cite

The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010-2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI admitted cases), with an average age of 54.6 years (median 56, limits 42-73 years). The average duration between the medically diagnosed AS and the actual associated spinal fracture(-s) moment was 21.4 years (median 23; limits 10-34 years). Low-energy trauma was incriminated in 54.5% cases. The spinal level of fracture was: cervical (four cases), thoracic (three), lumbar (four), assessed at admission as: American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (four subjects), C (five) and D (two). By the time of discharge, neither patient has neurologically deteriorated; five patients (45.5%) improved of at least grade 1 (AIS). The overall complications were mainly infections: symptomatic urinary tract infections (seven patients; 63.6%), pulmonary (three subjects; 27.3%) and spondylodiscitis (one case; 9%). The average follow-up period was 15.3 months (median 12; limits 1-48 months) after discharge; three subjects gained functional improvement to AIS-E. The clinical profile (different risk factors, mechanisms, types and levels of spinal fractures, additional encephalic and/or cord lesions, co-morbidities), different post-surgical and/or general complications acquired during admission in our rehabilitation ward, served us for future prevention strategies and a better therapeutic management.

show abstract

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

Anghelescu

Onose²,

Popescu

et al. 2016

Spinal Cord Ser Cases

View full text Add to dashboard Cite

show abstract

“…62 This clinical deterioration can be the result of well-known mechanisms, such as hematomas, edema, hypotension, hypoxemia, or inflammation. [63][64][65] The collar should, in theory, protect patients from secondary spinal cord traumas by restricting inadvertent movements of unstable CSIs. However, we will probably never know how many secondary SCIs collars have prevented.…”

Section: How Effective Are Cervical Collars?mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

144

115

View full text Add to dashboard Cite

The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.

show abstract

“…1,2,11 The spine is thus rendered more susceptible to fracture from smaller physical loads, 4,23 making standard intubation techniques difficult and sometimes impossible.…”

Section: Discussionmentioning

confidence: 99%

“…Although multiple reports have outlined treatment strategies for cervical fractures in patients with ankylosing spondylitis, 4,6,11,23 the incidence of new cervical fractures and spinal cord injuries that are specifically related to intubation in these patients appears to be exceedingly low. 6,10,19 Salathé and Jöhr reported the first such case in 1989, but pre-or postintubation radiographs were unavailable, leaving the etiology of the fracture unclear.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic neurological complications of emergent endotracheal intubation: report of 2 cases

Oppenlander

Hsu

Bolton

et al. 2015

SPI

View full text Add to dashboard Cite

Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6–7 fracturedislocation was identified, and the patient underwent emergent open reduction and C4–T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6–T1 decompression and fixation for a C6–7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6–7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members.

show abstract

Spinal Cord Injury in Patients With Ankylosing Spondylitis

Cited by 113 publications

References 17 publications

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Catastrophic neurological complications of emergent endotracheal intubation: report of 2 cases

Contact Info

Product

Resources

About