Surgical outcomes of traumatic cervical fractures in patients with ankylosing spondylitis

Neurocirugia (Astur : Engl Ed). May-Jun 2018;29(3):116-121. doi: 10.1016/j.neucir.2017.11.001. Epub 2018 Jan 12.
[Article in English, Spanish]

Abstract

Objective: Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies.

Methods: Between January 2004 and December 2014, 6 patients with ankylosing spondylitis and neurological complications after injuries were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Surgical decision was based on relationship of neurological involvement and spinal instability.

Results: A total of 6 cervical injuries were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 2 patients were associated with a hyperextension mechanism and 4 cases by flexion mechanism. Posttraumatic neurological deficits were demonstrated in all 6 cases and neurological improvement after surgery was observed in 4 of these cases. The two cases were not improved by the surgery was on a case by presenting a degree of Asia A and another patient who initially improved with surgery but died of pneumonia in the postoperative.

Conclusions: Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.

Keywords: Ankylosing spondylitis; Cervical spine fracture; Complicación neurológica; Espondilitis anquilosante; Estabilización espinal; Fractura de la columna cervical; Neurologic complication; Spinal stabilization.

MeSH terms

  • Aged
  • Cervical Vertebrae / injuries
  • Cervical Vertebrae / surgery*
  • Fractures, Spontaneous / etiology
  • Fractures, Spontaneous / surgery
  • Humans
  • Joint Dislocations / etiology
  • Joint Instability / etiology
  • Kyphosis / etiology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neck Injuries / complications
  • Osteoporosis / etiology
  • Postoperative Complications
  • Quadriplegia / etiology
  • Radiculopathy / etiology
  • Spinal Cord Injuries / etiology
  • Spinal Cord Injuries / prevention & control
  • Spinal Fractures / complications
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / surgery*
  • Spondylitis, Ankylosing / complications*
  • Tomography, X-Ray Computed
  • Treatment Outcome