Traumatic spinal cord injury complicating ankylosing spondylitis

Abstract

The aim of this paper is to review the incidence and characteristics found in traumatic spinal cord injury (SCI) occurring in patients with long-standing ankylosing spondylitis (AS). The incidence of patients with traumatic SCI admitted to our unit from January 1984 to February 1996 was 2% (15 out of 893). They were all men with a mean age of 56 years. Most frequently the etiology of the lesion was a motor vehicle accident and the injury was mainly due to a hyperextension mechanism. Acute spinal fracture occurred in 13 patients, all involving the cervical region. No fracture was observed in two patients with thoracic neurological level. Three patients presented with an interval free period of neurological symptoms in whom a spinal epidural hematoma was visualized with magnetic resonance imaging. On admission eight patients were diagnosed as having complete SCI and the other seven an incomplete SCI. In the acute phase, respiratory complications were most frequent, causing six patients to die. Treatment was conservative in 14 patients. Multidisciplinary management of these patients should be implemented in an institution equipped with both a Spinal Injury Unit and an Intensive Care Unit.

Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance

“…A higher incidence of cervical SCI has also been noted in the population with AS, accounting for up to 84% of all cord injuries, 1 in comparison to a 55% incidence of cervical SCI in the general spinal cord-injured population. 36 The incidence of complete SCI also appears to be higher in patients with AS 1,12,19,30,39 than in the general population. Patients with AS who sustain an SCI are older than the general spinal cord-injured population, with a mean age from 55 to 61 years in various series 1,5,34,39 compared with a mean age of 37 in the spinal cord-injured population at large.…”

“…36 The incidence of complete SCI also appears to be higher in patients with AS 1,12,19,30,39 than in the general population. Patients with AS who sustain an SCI are older than the general spinal cord-injured population, with a mean age from 55 to 61 years in various series 1,5,34,39 compared with a mean age of 37 in the spinal cord-injured population at large. 25 The higher incidence of SCI in AS is, of course, directly correlated with the increased incidence of vertebral column fractures in patients with AS.…”

“…Hyperextension was the most frequently observed mechanism of injury in a series of AS-related vertebral fractures, 1,19,20,30,39 although the author of one series noted that flexion mechanisms predominated in a cohort. 34 The prevalence of hyperextension injuries likely reflects the vulnerability of patients with AS to falls because of progressive kyphotic angulation and an inability to properly visualize the ground ahead while walking.…”

“…Retrospective case series of SCIs in patients with AS suggest that 1.5-2.0% of patients with such injuries also have AS, 1,34,39 an AS prevalence that is much higher than in the general population. Using Finnish national prevalence data, Alaranta et al 1 more recently determined that the incidence of SCI in patients with AS was 11.4 times Ͼ that in the population at large.…”

Ankylosing spondylitis: recent developments and anaesthetic implications

“…Clinically significant atlanto-axial subluxation occurs in 21% of patients with AS. About 47% of AS patients with vertebral compression fractures have a neurological complication ranging from paraesthesia to loss of muscle strength [17][18][19].…”