The Management of Spinal Injuries in Patients With Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis

Whang, Peter G.; Goldberg, Grigory; Lawrence, James P.; Hong, Joseph; Harrop, James S.; Anderson, D. Greg; Albert, Todd J.; Vaccaro, Alexander R.

doi:10.1097/bsd.0b013e3181679bcb

Cited by 124 publications

(88 citation statements)

References 16 publications

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“…Unfortunately, it has been shown that in a large percentage of cases, the correct diagnosis is not established until after the patient has already experienced a decline in neurologic function [17]. Unless there is a trauma with acute new back pain, spinal fracture in these patients may be easily overlooked.…”

Section: Discussionmentioning

confidence: 99%

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Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation

2011

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This study reviews the presentation, etiology, imaging characteristics and reasons for missed diagnosis of Andersson lesion (AL) and analyzes the surgical results of short segment fixation in the thoracolumbar region. This is a retrospective single center study. Fourteen patients (15 lesions) who were operated for AL were analyzed. The study was designed in two parts. The first part consisted of analysis of clinical and radiological features (MRI and radiographs) to highlight, whether definitive characteristics exist. The second part consisted of analysis of outcome of short segment fixation as measured by VAS, Frankel score, AsQoL index, and union, with assessment of complications. The follow-up was 42.33 ± 19.29 months (13 males and 1 female) with a mean age of 61.13 ± 19.74 years. There was predisposing trauma in five patients. There was a delay in presentation of the patients by 5.86 ± 2.50 months. There was misdiagnosis in all the cases, at primary orthopedic level (ten cases were put on anti-tuberculous treatment due to its MRI resemblance to infection) and all but one case at radiologist level. Radiographs and MRI had characteristic features in all cases, and MRI could detect posterior element affection in 14 lesions as against only 8 posterior lesions detected in radiographs. In all patients, there was a patient's delay and/or physician's delay to arrive at a diagnosis. Spinal fusion was seen in all the cases. Outcome measures of VAS, Frankel score, and AsQoL index showed significant improvement (P \ 0.002). No major complications occurred. There is a lack of awareness of AL leading to misdiagnosis. Definite clinico-radiological features do exist in AL and short segment fixation is effective.

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Section: Discussionmentioning

confidence: 99%

“…The initial radiograph of five patients with traumatic history was reported as without any bony injury in our series. The recognition of fractures and AL in individuals with AS may be complicated by their distorted bony anatomy and progressive deformity, making it more challenging to interpret radiographs [17]. Dilhman et al…”

Section: Discussionmentioning

confidence: 99%

Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation

2011

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“…Posttraumatic compressive epidural hematoma is commonly reported in 23% of the patients with AS. 26 Significant ossification of the ligaments increased the risk of epidural hematoma, favored bleeding from the epidural venous plexus and the fractured bone. 32 Literature mentioned the possible co-existence of two 33 or multiple spinal fractures 34,35 in the advanced AS.…”

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

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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.

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“…Enfin, selon Whang [16], une comparaison des fractures rachidiennes récentes liées à spondylarthrite et à la maladie hyperostosante de Forestier révèle que les troubles neurologiques sont plus graves sur les premières, sans constater de différence dans les traitements appliqués et les complications observées.…”

Section: Particularités Concernant Les Traumatismes Thoraco-lombairesunclassified

Chirurgie du rachis et spondylarthrite

Vital

Boissière

Obeid

et al. 2015

Revue du Rhumatisme Monographies

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The Management of Spinal Injuries in Patients With Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis

Cited by 124 publications

References 16 publications

Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation

Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation

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

Chirurgie du rachis et spondylarthrite

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