Surgical Treatment of Lumbar Hyperextension Injury in Ankylosing Spondylitis

Abstract

Ankylosing spondylitis (AS) is a chronic systemic and inflammatory rheumatic disease with a variable course of the axial skeleton. Spinal involvement may accompany ossification of the ligaments, intervertebral disc, end-plates and apophyseal structures, and seems to be "bamboo spine". Because of these natures of the spine in AS, a spinal fracture can be occurred with minor trauma or spontaneously. The fracture of the AS can cause neurological complications extremely high, so special attention to prevent neurological deterioration. Operative management of the injured spine with AS is difficult, and associated with a high complication rate. Extreme care must be taken for surgery to prevent secondary neurological deterioration.

A Comparison of Open and Percutaneous Techniques in the Operative Fixation of Spinal Fractures Associated with Ankylosing Spinal Disorders

“…Furthermore, the tendency of ankylosing patients to autofuse lends a theoretical advantage to MIS techniques with osteosynthesis (rather than arthrodesis), which are essentially internal fixation techniques. In both previous literature and in our case series, these patients are elderly with multiple medical comorbidities, 3 making the proposed benefits of MIS techniques valuable.…”

Is Long-Segment Fixation a Rule in Fractures Associated With Ankylosing Spondylitis?

“…4 Due to the stiffness, patients are extremely susceptible to fractures of the spine even following trivial trau- ma. 5,6 The spinal fractures involve all 3 columns secondary to hyperextension injuries and behave like Chance fractures. 7 The horizontal fracture line can run through vertebral body (bony Chance) or disc space (soft tissue Chance).…”

“…3,9 In view of the focal instability at the fracture most surgeons/doctors advocate long-segment instrumented fusion. 3,6,10 Generally, the mortality of surgicallytreated AS patients is higher than the normal population sustaining spinal trauma. 6 Again, in patients with AS who are medically unfit for surgery, the issues related to management are further complicated in the absence of any set protocol.…”

“…3,6,10 Generally, the mortality of surgicallytreated AS patients is higher than the normal population sustaining spinal trauma. 6 Again, in patients with AS who are medically unfit for surgery, the issues related to management are further complicated in the absence of any set protocol. Brace treatment has been attempted in such cases with questionable relief and poor results.…”

“…Brace treatment has been attempted in such cases with questionable relief and poor results. 6,11,12 Specifically, brace treatment in AS patients has high incidence of pseudoarthrosis and consequent pain leading to delay in mobilization, which adds to the morbidity. 6,[13][14][15] Strategies to deal with such patients with persistent pain and high medical comorbidities that preclude surgery are lacking in the literature.…”