Surgical Treatment of Cervical Spine Fracture in a Patient with Ankylosing Spondylitis

Цель исследования. Анализ результатов и методов хирургического лечения пациентов с переломами в шейном и грудопоясничном отделах позвоночника при анкилозирующем спондилите. Материал и методы. Под наблюдением находились 19 пациентов с анкилозирующим спондилитом, у 7 из которых диагностирован перелом позвоночника. Средний возраст больных с переломами-39 лет (32-58 лет). Повреждения в шейном отделе отмечены у трех пациентов, в поясничном-у четырех. Среди больных с повреждениями в поясничном отделе у одного пациента с предшествующей кифотической деформацией наблюдали клиническую картину глубокого нижнего пареза, у двух, с переломом на уровне С 5-С 6 ,-параплегию, у одного, с повреждением на уровне С 5-С 6 ,-корешковый болевой синдром. У остальных пациентов неврологических расстройств не было. Больные оперированы в сроки от трех дней до двух недель после травмы. Для уточнения диагноза проводили КТ. При повреждениях в шейном отделе выпоняли переднюю фиксацию, повреждения в пояснично-грудном отделе фиксировали транспедикулярными конструкциями. Результаты. Результаты оценивали по данным рентгенографии и КТ, а также по степени неврологического регресса. Осложнений, демонтажа или увеличения деформации не отмечали. У одного пациента с корешковой ирритацией и переломом в шейном отделе боли купировали. У одного пациента с переломом на уровне Th 12-L 1 отмечен регресс неврологических осложнений с Frankel B до Frankel D. Заключение. Хирургическая стабилизация позвоночника является методом выбора в лечении переломов при анкилозирующем спондилите. Дозированная коррекция кифотической деформации при переломах может быть одним из элементов хирургического лечения.

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Anterior and Posterior Fixation of Spinal Fracture in Patients With Ankylosing Spondylitis

Shvets¹,

Nekhlopochin²,

Самойленко³

et al. 2017

“…В отечественной литературе детально освещены вопросы показаний, оперативной техники при анкилозирующем спондилите в грудопоясничном отделе позвоночника [4], а описания хирургического лечения повреждений в шейном отделе встречаются в единичных сообщениях [1][2][3]. В зарубежной литературе этой проблеме в последние годы уделяется достаточно внимания [9,13,32,39].…”

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Surgical Treatment of Cervical Spine Fractures in Patients With Ankylosing Spondylitis

Ардашев¹,

Гатин²,

Ardasheva³

et al. 2013

To analyze the results of surgery for cervicothoracic deformity fractures in patients with ankylosing spondylitis. Material and Methods. Retrospective review of treatment for fractures of cervicothoracic deformity in 6 patients with ankylosing spondylitis was performed. All patients had transdiscal fractures caused by low-energy trauma, most frequently at C5-C6 and C6-C7 levels. Each patient had at least one comorbidity. The spinal cord was injured in 100 % of cases. Results. Postoperative complications were registered in all patients. Analysis of postoperative x-rays showed that spinal deformity was corrected in most cases, and the stable fixation was achieved at the operated level of the spine. Three patients who had underwent anterior fixation showed the regression of neurological symptoms. Patients classified as Frankel A died of cardiopulmonary insufficiency at 2-7 days after surgery without any signs of neurological symptom regression. Autopsy revealed severe spinal cord injury. Mortality rate was 50 %. Conclusion. Surgical treatment of cervical spine fractures providing a stable fixation reduces the risk of complications and allows for early activation of patients with ankylosing spondylitis.

Experience in surgical treatment of patients with traumatic spinal injuries associated with ankylosing spondylitis

Basankin,

Giulzatyan,

Afaunov

et al. 2024

Objective. To analyze characteristics, diagnostic features and results of surgical treatment of patients with traumatic spinal injuries associated with ankylosing spondylitis.Material and Methods. A retrospective analysis of the results of surgical treatment of 32 patients (25 men and 7 women) operated on in 2019–2022 was performed. Results were followed-up during 12 months in all patients. Patient characteristics, diagnostic features,clinical outcomes, and the range of postoperative complications were reviewed.Results. The number of damaged levels in the cervical, thoracic and lumbar spine was 39. Low-energy injury (fall from a height and from a sitting position) was observed in 20 patients (62.5 %), and high-energy injury (fall from a height of more than 1 m and a road trafficaccident) – in 12 patients (37.5 %). Type B3 fractures according to the AOSpine classification were present in 23 patients (71.8 %), and type C translational fractures – in 9 (28.2 %). CT of the spine and verification of the diagnosis were performed within 24 hours after the injury in 24 patients (75 %). The remaining 8 (25 %) patients underwent primary diagnosis later – in 19.8 ± 24.4 days (range 5–46 days). All patients underwent posterior fixation with or without decompression. The time of surgical intervention depended on the presence of neurological symptoms. Twenty one (65.6 %) patients with complicated injury underwent surgical intervention within 8 hours after admission to the hospital. In the remaining 11 (34.4 %) neurologically uncomplicated patients, operations were performed within 3.2 ± 1.4 days. In-hospital mortality was 6.25 % (n = 2), and 1-year mortality was 28 % (n = 9). There were no neurological symptoms before or after surgery in 11 patients (36.7 %). In the group of patients with initial neurological complications (n = 21), 3 (14.3 %) patientshad complete regression of neurological symptoms (from AIS D to AIS E), 4 (19 %) - incomplete regression of symptoms (from AIS C to AIS D), and 14 (66.7 %) patients did not show significant positive dynamics. Pulmonary embolism (PE) and pneumonia were observed in 5 (15.6 %) and 6 (18.75 %) patients, respectively. In the postoperative period, the deep vein thrombosis of the lower extremities was most frequent (n = 9; 28.1%), and in 5 cases it was complicated by PE.Conclusion. The basis for diagnosing fractures in patients with ankylosing spondylitis is clinical data (increased pain after a fall and/or the appearance of neurological deficit) and radiological data (CT scan of the whole spine). Fractures in ankylosing spondylitis are characterized by absolute instability with a high risk of developing secondary neurological deficits in the case of conservative treatment or delayed surgical intervention. The essence of the surgery is the use of extended fixation with 8 screws in the cervical spine and more than 10 screws in the thoracic and lumbar spine. The most common complications of the early postoperative period include liquorrhea, surgical wound suppuration, pulmonary embolism, pneumonia, and loosening of transpedicular screws.