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Daher M, Rezk A, Baroudi M, Gregorczyk J, Balmaceno Criss M, McDermott J, Mcdonald CL, Diebo BG, Daniels AH. Management of Thoracolumbar Vertebral Fractures and Dislocations in Patients with Ankylosing Conditions of the Spine. Orthop Rev (Pavia) 2024; 16:94279. [PMID: 38435438 PMCID: PMC10908592 DOI: 10.52965/001c.94279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are bone-forming spinal conditions which inherently increase spine rigidity and place patients at a higher risk for thoracolumbar fractures. Due to the long lever-arm associated with their pathology, these fractures are frequently unstable and may significantly displace leading to catastrophic neurologic consequences. Operative and non-operative management are considerations in these fractures. However conservative measures including immobilization and bracing are typically reserved for non-displaced or incomplete fractures, or in patients for whom surgery poses a high risk. Thus, first line treatment is often surgery which has historically been an open posterior spinal fusion. Recent techniques such as minimally invasive surgery (MIS) and robotic surgery have shown promising lower complication rates as compared to open techniques, however these methods need to be further validated.
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Ye J, Jiang P, Guan H, Wei C, Li S, Jia M, Li N. Surgical treatment of thoracolumbar fracture in ankylosing spondylitis: A comparison of percutaneous and open techniques. J Orthop Surg Res 2022; 17:504. [PMID: 36434588 PMCID: PMC9694850 DOI: 10.1186/s13018-022-03378-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/30/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND CONTEXT Posterior percutaneous long-segment internal fixation and open fixation with long-segment screws have been used to treat thoracolumbar fractures in ankylosing spondylitis patients. PURPOSE To observe the clinical effect of posterior percutaneous long-segment internal fixation in 26 ankylosing spondylitis (AS) patients with thoracolumbar fractures. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Forty-seven AS patients who were diagnosed with thoracolumbar fractures and treated from December 2014 to December 2018. OUTCOME MEASURES Visual analog scale score, Cobb angle, American Spinal Injury Association Grade, SF-Qualiveen score, pedicle screw misplacement rate, operative duration, blood loss, complications, bed rest duration and modified MacNab score. METHODS All patients were divided into the percutaneous group (PG) and the open group. Twenty-six patients were treated with percutaneous long-segment internal fixation, and the remaining 21 underwent open fixation with long-segment screws. The minimum follow-up period was 12 months. RESULTS The operations were successful in both groups. A patient in the PG showed class C wound healing, while the others showed class A healing, and some patients experienced perioperative complications. All patients were followed up for 12-48 months (mean, 33.81 months), and all patients showed clinical osseous fracture healing. Significant differences were found in operative duration, intraoperative blood loss and postoperative bed rest duration between the two groups (P < 0.05). No significant difference was found in improvement of the visual analog scale score, Cobb angle of spinal kyphosis or neurological function after the operation (P > 0.05). CONCLUSIONS As a minimally invasive procedure, posterior percutaneous long-segment internal fixation requires less time, results in less blood loss and causes less trauma. This procedure can also improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to those of traditional methods. With this curative clinical effect, this procedure can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients, especially for elderly patients with underlying diseases and high surgical risk.
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Affiliation(s)
- JingYao Ye
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ping Jiang
- grid.412540.60000 0001 2372 7462Department of Orthopaedics, Shanghai University of Traditional Chinese Medicine, Shanghai, China ,grid.412540.60000 0001 2372 7462Department of Orthopaedics, Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - HuaPeng Guan
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - ChuanFu Wei
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Sen Li
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - MengLong Jia
- grid.461885.6Department of Orthopaedics, Weifang Hospital of Traditional Chinese Medicine, Weifang, China
| | - NianHu Li
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Ikuma H, Hirose T, Takao S, Ueda M, Yamashita K, Otsuka K, Kawasaki K. The impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fracture with ankylosing spinal disorder. J Neurosurg Spine 2022; 36:784-791. [PMID: 34826809 DOI: 10.3171/2021.8.spine21996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with ankylosing spinal disorders (ASDs), such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, often have rigid kyphosis of the spine. The fracture site is sometimes unintentionally displaced when surgery is conducted with the patient prone. To prevent this incident, the authors adopted the lateral decubitus position for patients intraoperatively for this pathology. The aim of this study was to retrospectively assess the impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fractures with ASD. METHODS Thirty-seven consecutive patients who underwent posterior instrumentation for thoracolumbar fracture with ASD at the authors' institute were divided into 15 lateral decubitus positions (group L) and 22 prone positions (group P). Surgical time, estimated blood loss (EBL), number of levels fused, perioperative complications, length of stay (LOS), ratio of fracture voids, and ratio of anterior wall height were investigated. The ratio of fracture void and the ratio of anterior wall height were the radiological assessments showing a degree of reduction in vertebral fracture on CT. RESULTS Age, sex, BMI, fracture level, and LOS were similar between the groups. Levels fused and EBL were significantly shorter and less in group L (p < 0.001 and p = 0.04), but there was no significant difference in surgical time. The complication rate was similar, but 1 death within 90 days after surgery was found in group P. The ratio of fracture voids was 85.4% ± 12.8% for group L and 117.5% ± 37.3% for group P. A significantly larger number of patients with a fracture void ratio of 100% or less was found in group L (86.7% vs 36.4%, p = 0.002). The ratio of anterior wall height was 107.5% ± 12.3% for group L and 116.9% ± 18.8% for group P. A significantly larger number of patients with the anterior wall height ratio of 100% or less was also found in group L (60.0% vs 27.3%, p = 0.046). CONCLUSIONS The results of this study suggest that the lateral decubitus position can be expected to have an effect on closing or maintaining the fracture void or a preventive effect of intraoperative unintentional extension displacement of the fractured site, which is often seen in the prone position during surgery for thoracolumbar fractures involving ASD.
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Affiliation(s)
- Hisanori Ikuma
- 1Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa
| | - Tomohiko Hirose
- 1Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa
| | - Shinichiro Takao
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama; and
| | - Masataka Ueda
- 1Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa
| | - Kazutaka Yamashita
- 1Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa
| | | | - Keisuke Kawasaki
- 1Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa
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Cirillo T. JI, Gimbernat R. M, Farías M. I, Hernández Vargas G, Urzúa B. A, Ballesteros P. JV. Hyperextension-distraction fractures in ankylosing and spondylotic spines: injury profile and treatment results. INTERNATIONAL ORTHOPAEDICS 2022; 46:889-895. [DOI: 10.1007/s00264-022-05310-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
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Kandregula S, Birk HS, Savardekar A, Newman WC, Beyl R, Trosclair K, Guthikonda B, Sin A. Spinal Fractures in Ankylosing Spondylitis: Patterns, Management, and Complications in the United States - Analysis of Latest Nationwide Inpatient Sample Data. Neurospine 2022; 18:786-797. [PMID: 35000333 PMCID: PMC8752689 DOI: 10.14245/ns.2142712.356] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Ankylosing spondylitis (AS) is a rheumatic inflammatory disease marked by chronic inflammation of the axial skeleton. This condition, particularly when severe, can lead to increased risk of vertebral fractures attributed to decreased ability of the stiffened spinal column to sustain normal loads. However, little focus has been placed on understanding the locations of spinal fractures and associated complications and assessing the correlation between these. In this review, we aim to summarize the complications and treatment patterns in the United States in AS patients with spinal fractures, using the latest Nationwide Inpatient Sample (NIS) database (2016–2018).
Methods We analyzed the NIS data of years 2016–2018 to compare the fracture patterns and complications.
Results A total of 5,385 patients were included. The mean age was 71.63 years (standard deviation [SD], 13.21), with male predominance (83.8%). The most common population is Whites (77.4%), followed by Hispanics (7.9%). The most common fracture level was thoracic level (58.3%), followed by cervical level (38%). Multiple fracture levels were found in 13.3% of the patients. Spinal cord injury (SCI) was associated with 15.8% of the patients. The cervical level had a higher proportion of SCI (26.5%), followed by thoracic level (9.2%). The mean Elixhauser comorbidity score was 4.82 (SD, 2.17). A total of 2,365 patients (43.9%) underwent surgical treatment for the fractures. The overall complication rate was 40.8%. Respiratory complications, including pneumonia and respiratory insufficiency, were the predominant complications in the overall cohort. Based on the regression analysis, there was no significant difference (p=0.45) in the complication rates based on the levels. The presence of SCI increased the odds of having a complication by 2.164 times (95% confidence interval, 1.722–2.72; p≤0.001), and an increase in Elixhauser comorbidity score predicted the complication and in-hospital mortality rate (p≤0.001).
Conclusion AS patients with spinal fractures have higher postoperative complications than the general population. The most common fracture location was thoracic in our study, although it differs with few studies, with SCI occurring in 1/6th of the patients.
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Affiliation(s)
- Sandeep Kandregula
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Harjus S Birk
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Amey Savardekar
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | | | - Robbie Beyl
- Department of Statistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Krystle Trosclair
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Anthony Sin
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
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Chekhonatsky VA, Dreval ON, Kuznetsov AV, Gorozhanin AV, Sidorenko VV. [Surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:71-76. [PMID: 35758081 DOI: 10.17116/neiro20228603171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the features of diagnosis and surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis. MATERIAL AND METHODS We present a patient with ankylosing spondylitis, blunt thoracic spine trauma and Th10-Th11 fracture, spinal cord compression and contusion and moderate lower extremity paresis. Preoperative and postoperative CT and MRI (after 8 months) were performed for control of decompression. RESULTS The authors identified the main factors affecting the quality of life of patients with spine fractures following ankylosing spondylitis and formulated treatment algorithm. CONCLUSION Active strategy is advisable for spine fractures following ankylosing spondylitis: spinal cord decompression, creation of anatomical compliance in the damaged vertebral segment and its fixation by transpedicular system. A similar surgical treatment of spine fractures following ankylosing spondylitis makes it possible to achieve early activation of patients and reduce rehabilitation period.
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Affiliation(s)
- V A Chekhonatsky
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - O N Dreval
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - A V Kuznetsov
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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Sharma M, Jain N, Wang D, Ugiliweneza B, Boakye M, Drazin D. Impact of age on mortality and complications in patients with Ankylosing Spondylitis spine fractures. J Clin Neurosci 2021; 95:188-197. [PMID: 34929644 DOI: 10.1016/j.jocn.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to study the impact of age on in-hospital complications and mortality following surgery for Ankylosing Spondylitis (AS) associated spine fractures. METHODS We extracted data from the Nationwide Inpatient Sample (NIS) database (1998-2018) using ICD-9/10 codes. Patients with a primary diagnosis of AS associated spine fractures who underwent fusion surgery were included. Complications and in-hospital mortality were analyzed. RESULTS A total cohort of 8526 patients was identified. Overall, the median age of the cohort was 69 years. AS associated fractures were equally distributed among cervical and thoracolumbar regions. Overall, complications were noted in 48% of patients and pulmonary complications were the most common (32%) followed by renal (13%) and infection (12%). Complications were seen in 57.3% of patients ≥ 70 years of age compared to 38.4% of patients < 70 years of age (p < .0001). Also, 9.9 % of patients ≥ 70 years of age had in-hospital mortality compared to 3.1 % of patients < 70 years of age (p < .0001). Based on surgical approaches, elderly patients (≥70 years) who underwent anterior, posterior, and anterior + posterior approaches had 19.8%, 7.4% and 16.4% in-hospital mortality compared to 5.3%, 2.2% and 7.4% respectively for patients < 70 years. CONCLUSIONS Elderly patients (≥70 years of age) were 3.2 times more likely to have in-hospital mortality and higher complications compared to younger patients (57% vs. 38%). Cervical compared to thoracolumbar fractures and anterior compared to posterior surgical approaches were associated with higher complications and in-hospital mortality.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA
| | - Nikhil Jain
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA; Kentucky Spinal Cord Injury Research Center, School of Medicine, University of Louisville, Louisville, KY, USA; Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA; Kentucky Spinal Cord Injury Research Center, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Doniel Drazin
- Pacific Northwest University of Health Sciences, Yakima, WA, USA.
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Chia Hua L, Mokhtar SA. Thoracolumbar Fracture in Disseminated Idiopathic Skeletal Hyperostosis. Cureus 2021; 13:e15222. [PMID: 34188976 PMCID: PMC8232923 DOI: 10.7759/cureus.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Disseminated idiopathic skeletal hyperostosis (DISH) is a form of ankylosing spinal disorders, which is at high risk of fracture because of the rigidity of the spinal column and reduced bone quality. The patients with DISH are at higher risk of fall because of the poor muscle tone, rigid spine column, and positive sagittal balance. The management of spinal fractures in these patients proves to be challenging because of the altered biomechanics and alignment of the spine. Furthermore, most patients have multiple comorbidities with high intraoperative burden, and osteoporosis itself will impair any implant purchase of the bone. Here, we report a case of thoracolumbar fracture in DISH where both conservative and surgical approaches were utilized, with unfortunate results in both, and a brief review of the literature on its management.
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Affiliation(s)
- Lim Chia Hua
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, MYS
| | - Sabarul A Mokhtar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, MYS
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Shah NG, Keraliya A, Harris MB, Bono CM, Khurana B. Spinal trauma in DISH and AS: is MRI essential following the detection of vertebral fractures on CT? Spine J 2021; 21:618-626. [PMID: 33130303 DOI: 10.1016/j.spinee.2020.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Both ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) cause a rigid spine, but through different pathophysiology. Recent data has shown that characteristic fracture patterns may also differ following trauma since the posterior osseous and soft tissue elements are often spared in DISH. CT and MRI are important in diagnosing spine injury, but given the differences between AS and DISH, the utility of obtaining both studies in all patients warrants scrutiny. PURPOSE To assess the prevalence of posterior element injury on CT and MRI in DISH and AS patients with known vertebral body injury detected on CT; to determine whether MRI demonstrates additional injuries in neurologically intact patients presumed to have isolated vertebral body injuries on CT. STUDY DESIGN Multicenter, retrospective, case-control study. PATIENT SAMPLE DISH and AS patients presenting after spine trauma between 2007 and 2017. OUTCOME MEASURES Review of CT and MRI findings at the time of presentation. METHODS One hundred sixty DISH and 85 AS patients presenting after spine trauma were identified from 2 affiliated academic hospitals serving as level 1 trauma and tertiary referral centers. A diagnosis of DISH or AS was verified by a board-certified emergency radiologist with 3 years of experience. Age, gender, mechanism of injury, fracture type, spine CT and MRI imaging findings, surgical intervention, and neurologic deficit were recorded. The CT and MRI studies were reviewed by the same radiologist for fracture location and type using the AO spine classification. No funding source or conflict of interest was present. RESULTS Median age was 72 and 79 years old for the AS and DISH groups, respectively. Both were predominantly male (81%) and most presented after a low energy mechanism of injury (74% and 73%). Type C AO spine injuries were seen in 52% of AS patients but only 4% of DISH patients. In patients with known vertebral body injury on CT, additional injury to the posterior elements on CT or MRI in DISH patients was 51% versus 92% in AS patients. However, in patients with an isolated vertebral body fracture on CT and no neurological deficit, MRI identified posterior element injury in only 4/22 (18%) DISH patients compared to 5 of 7 (71%) AS patients. None of the MRI findings in the DISH patients were considered clinically important while all 5 AS patients eventually underwent operative treatment despite having no neurological deficit. Epidural hematoma on MRI was seen in 43% of AS patients as opposed to 5% of DISH patients. CONCLUSION Based on our small sample size, CT alone may be adequate in DISH patients with isolated vertebral body fractures and no neurologic deficit, but an additional MRI should be considered in the presence of an unclear neurological exam or deficit. MRI should be strongly considered for any AS patient regardless of neurologic status.
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Affiliation(s)
- Nandish G Shah
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Abhishek Keraliya
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Mitchel B Harris
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Christopher M Bono
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Bharti Khurana
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA.
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Alahmari ASA, Qari SK, Asiri RI, Almohammadi TA, Alalawi MA, Aljahdali HM, Alnasser AH, Alaqeel FA, Kazim OA, Qasem HAO. An Overview on the Role of Surgical Management in Ankylosing Spondylitis. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/9azbvu4zlt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Chung WH, Ng WL, Chiu CK, Chan C, Kwan MK. Minimally Invasive versus Conventional Open Surgery for Fixation of Spinal Fracture in Ankylosed Spine. Malays Orthop J 2020; 14:22-31. [PMID: 33403059 PMCID: PMC7752011 DOI: 10.5704/moj.2011.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: This was a retrospective study aimed to investigate the perioperative outcomes of long construct minimally invasive spinal stabilisation (MISt) using percutaneous pedicle screws (PPS) versus conventional open spinal surgery in the treatment of spinal fracture in ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). Material and Methods: Twenty-one patients with AS and DISH who were surgically treated between 2009 and 2017 were recruited. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union rate. Results: Mean age was 69.2 ± 9.9 years. Seven patients had AS and 14 patients had DISH. 17 patients sustained AO type B3 fracture and 4 patients had type B1 fracture. Spinal trauma among these patients mostly involved thoracic spine (61.9%), followed by lumbar (28.6%) and cervical spine (9.5%). MISt using PPS was performed in 14 patients (66.7%) whereas open surgery in 7 patients (33.3%). Mean number of instrumentation level was 7.9 ± 1.6. Mean operative time in MISt and open group was 179.3 ± 42.3 minutes and 253.6 ± 98.7 minutes, respectively (p=0.028). Mean intra-operative blood loss in MISt and open group was 185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001). Complications and union rate were comparable between both groups. Conclusion: MISt using PPS lowers the operative time and reduces intra-operative blood loss in vertebral fractures in ankylosed disorders. However, it does not reduce the perioperative complication rate due to the premorbid status of the patients. There was no significant difference in the union rate between MISt and open surgery.
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Affiliation(s)
- W H Chung
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - W L Ng
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - C K Chiu
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Cyw Chan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - M K Kwan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Kuperus JS, Mohamed Hoesein FAA, de Jong PA, Verlaan JJ. Diffuse idiopathic skeletal hyperostosis: Etiology and clinical relevance. Best Pract Res Clin Rheumatol 2020; 34:101527. [PMID: 32456997 DOI: 10.1016/j.berh.2020.101527] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic bone-forming condition characterized by the presence of at least three bony bridges at the anterolateral spine. The aim of this review was to address the present state of pathophysiological knowledge, the clinical relevance, and diagnosis of DISH. The pathogenesis of DISH is currently unknown. The presence of DISH has been associated with older age, male sex, obesity, hypertension, atherosclerosis, and diabetes mellitus. Because the new bone forms mainly at entheseal sites, local fibroblasts, chondrocytes, collagen fibers, and calcified matrix are probably influenced by genetic, vascular, metabolic, and mechanical factors. Diagnosing the presence of DISH is of clinical importance, because the risk of a spinal fracture increases and associations with the metabolic syndrome, coronary and aortic disease, and respiratory effects are strong. Unravelling the pathogenesis of DISH can impact the field of regenerative medicine and bone tissue regeneration.
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Affiliation(s)
- Jonneke S Kuperus
- Department of Orthopedics, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands.
| | - Firdaus A A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands
| | - Jorrit Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands
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Kurucan E, Bernstein DN, Mesfin A. Surgical management of spinal fractures in ankylosing spondylitis. JOURNAL OF SPINE SURGERY 2018; 4:501-508. [PMID: 30547111 DOI: 10.21037/jss.2018.06.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skeleton. Structural changes render the spine susceptible to fractures, which can be treated operatively or non-operatively. The preferred surgical approach is not well established. The objective of this study is to evaluate trends in the surgical treatment of AS patients with cervical and thoracolumbar spine fractures. Methods Using the nationwide inpatient sample (NIS) database, we identified 961 (4,683 weighted) AS patients from 2003 to 2014 who had fusion surgery for vertebral fractures. Our primary outcome was the national trend in use of posterior (PSF), anterior posterior (APSF), and anterior fusion (ASF) surgeries. In addition, we examined patient demographics, complications, institutional characteristics, and hospitalization lengths and costs. Results The number of fusions performed in AS patients with fractures increased significantly (P<0.01). The proportion of cervical fractures receiving fusions stayed consistent, whereas that of thoracolumbar fractures increased significantly (P<0.01). Patients undergoing APSF had higher hospitalization lengths in cervical and thoracolumbar fractures (P<0.01). There was significant association between pulmonary complications and cervical fusions (P<0.01). Conclusions Surgical treatment has been growing in popularity for thoracolumbar fractures but staying consistent for cervical fractures in AS patients. Surgical approach has shifted for cervical fractures with APSF transitioning from most to least popular approach from 2003 to 2014. For thoracolumbar fractures, PSF has remained the preferred approach. APSF had significantly higher pulmonary complication rates with cervical fractures. This finding can help surgeons in treating fractures in AS patients with underlying pulmonary disease.
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Affiliation(s)
- Etka Kurucan
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - David N Bernstein
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
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Dru AB, Kubilis PS, Murad GA, Carney T, Hoh DJ. Radiographic and Neurological Outcome After Surgical Treatment of Traumatic Fractures of the Ankylotic Thoracic Spine: A Retrospective Case Series. Oper Neurosurg (Hagerstown) 2018; 14:224-230. [PMID: 29462447 DOI: 10.1093/ons/opx099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Spontaneous thoracic ankylosis is a progressive degenerative process that predisposes patients to potentially highly unstable traumatic injuries. Acute hyperextension fractures result in dynamic instability putting the spinal cord at risk. OBJECTIVE To describe preoperative radiographic characteristics of fractures of the ankylotic thoracic spine and relate findings to early postoperative radiographic and clinical outcomes. METHODS A single center, retrospective review was performed of 28 surgically treated patients with fractures of the ankylotic thoracic spine. Radiographic assessment included preoperative fracture angulation (FA) and fracture displacement (FD), and postoperative change in sagittal alignment. Early clinical outcomes included preoperative and postoperative American Spinal Injury Association (ASIA) grade and perioperative complications. RESULTS Seven patients (25%) presented with poor neurological grade (ASIA A-C) compared to 21 (75%) with good grade (ASIA D, E). At presentation, poor grade patients had a mean FA of 16.4° (range 0°-34.5°), and FD of 7.76 mm (range 0.8-9.2). Good grade patients had a mean FA of 18.2° (range 0°-43.3°), and FD of 4.77 mm (range 0-25.1). There was no statistically significant difference in FA or FD between groups (P = .70 and .20 respectively). All underwent posterior pedicle screw fixation for stabilization. Fifty per cent of patients presenting with ASIA C or D spinal cord injury improved 1 or more ASIA grades. There were no perioperative complications. Early postoperative sagittal alignment was maintained with a mean change of -2.6°. CONCLUSION Presenting fracture alignment does not significantly correlate with pre- or postoperative neurological status. Early posterior stabilization preserved neurological function, with neurological recovery occurring in a portion of individuals.
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Affiliation(s)
- Alexander B Dru
- Lillian S. Wells Department of Neuro-surgery, University of Florida, Gainesville, Florida
| | - Paul S Kubilis
- Lillian S. Wells Department of Neuro-surgery, University of Florida, Gainesville, Florida
| | - Gregory A Murad
- Lillian S. Wells Department of Neuro-surgery, University of Florida, Gainesville, Florida
| | - Tyler Carney
- Lillian S. Wells Department of Neuro-surgery, University of Florida, Gainesville, Florida
| | - Daniel J Hoh
- Lillian S. Wells Department of Neuro-surgery, University of Florida, Gainesville, Florida
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Faqeeh A, Yen D. Successful Nonoperative Treatment of a Lumbar Spine Extension Injury with Disruption of all Three Bony Columns in a Patient with Ankylosing Spondylitis - A Case Report. Open Neurol J 2017; 11:92-97. [PMID: 29399213 PMCID: PMC5761021 DOI: 10.2174/1874205x01711010092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022] Open
Abstract
STUDY DESIGN A case report. BACKGROUND Patients with ankylosing spondylitis have altered spinal biomechanics putting them at increased risk of spinal fractures that are unstable. As a result there is an increasing trend to treat these fractures with surgical stabilization. We hypothesize that the fracture pattern is also an important factor in patients with this disease and that those with an extension injury in the lumbar spine can be treated with brace immobilization. OBJECTIVE Report on the non-operative management of an elderly patient, with ankylosing spondylitis, who sustained an extension injury of all three bony columns of the lumbar spine. METHODS A case report of a 70-year-old man who fell from a standing height, sustaining a three-column fracture at L1-2, who did not want surgical stabilization. RESULTS External brace immobilization was used and the patient was closely monitored. At his final 13 month follow-up, the patient had no clinical evidence of spinal instability or neurologic compromise and radiologically we could see callous formation anteriorly and laterally between the L1 and L2 vertebral bodies.These bridged the trebeculae across the middle and posterior columns at L1 and L2 on the lateral view, and there was no change in the sagittal or coronal alignment" to "There was mature bridging bone across the middle and posterior columns at L1 and L2 on the lateral view, and there was no change in the sagittal or coronal alignment. CONCLUSION This case supports our hypothesis that the fracture pattern is an important factor in patients with ankylosing spondylitis and adds to the body of knowledge in the scientific literature concerning non-operative treatment of fractures in patients with ankylosed spines. Further study is required to determine whether ours is an isolated case or whether this applies to a wider population of ankylosing spondylitis patients.
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Affiliation(s)
- Ali Faqeeh
- Division of Orthopaedic Surgery, Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - David Yen
- Division of Orthopaedic Surgery, Department of Surgery, Queen’s University, Kingston, Ontario, Canada
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Isogai N, Asamoto S, Nakamura S, Sakurai K, Ishihara S, Ishikawa M, Nishiyama M, Yoshioka F, Samura K, Kawashima M. Spine and Spinal Cord Injury Associated with a Fracture in Elderly Patients with Ankylosing Spondylitis. Neurol Med Chir (Tokyo) 2017; 58:103-109. [PMID: 29269632 PMCID: PMC5929918 DOI: 10.2176/nmc.oa.2017-0112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
There are few cases of spinal cord injury with ankylosing spondylitis (AS). This study investigated the clinical results of a spinal cord injury with a fracture in elderly patients with AS. Nine patients who had sustained a spinal cord injury with vertebral fractures in ankylosed spines were included in this study. The mean age was 79.3 years; two were male and seven were female. The mechanism of injury, the level of vertebral fractures, clinical methods, the follow-up period, and treatment outcomes were investigated. The mechanism of injury of six cases was a fall and in the others was a slip. The levels of vertebral fractures were a cervical lesion (n = 5), a thoracic lesion (n = 3), and a lumbar lesion (n = 1). Six cases underwent a surgical procedure with posterior fusion and decompression, two cases were treated only with a brace, and one case was treated with a halo vest. The mean follow-up period was 4.3 years. The neurological deficit treatment outcomes were improved or no change in four cases each and one case had died. There was not much difference in treatment outcomes between a surgical treatment and a conservative treatment. Computed tomography imaging to evaluate the entire spine is required in all patients with AS with a possible spinal fracture. A surgical treatment and early rising and rehabilitation should be recommended for patients with fractures and AS to avoid further complications, not from the standpoint of improving the neurological status.
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Affiliation(s)
- Norihiro Isogai
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital
| | - Shunji Asamoto
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital.,Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Satoshi Nakamura
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital
| | - Kiminori Sakurai
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital.,Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Shinichi Ishihara
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital
| | - Masayuki Ishikawa
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital
| | - Makoto Nishiyama
- Spine and Spinal Cord Center, School of Medicine, International University of Health and Welfare, Mita Hospital
| | - Fumitaka Yoshioka
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Kazuhiro Samura
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Masatou Kawashima
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
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Transpseudarthrosis Osteotomy with Interbody Fusion for Kyphotic Spinal Pseudarthrosis in Ankylosing Spondylitis by a Single Posterior Approach: A Retrospective Study and a Brief Relevant Literature Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4079849. [PMID: 28875150 PMCID: PMC5569875 DOI: 10.1155/2017/4079849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/13/2017] [Indexed: 12/28/2022]
Abstract
Objective To explore the safety and efficacy of transpseudarthrosis osteotomy with interbody fusion in the treatment of Ankylosing Spondylitis (AS) patients with kyphotic spinal pseudarthrosis by a single posterior approach. Methods Twelve consecutive patients with spinal pseudarthrosis underwent transpseudarthrosis osteotomy and interbody fusion with a polyetheretherketone (PEEK) cage by a single posterior approach. The operative time, intraoperative blood loss, and complications were recorded. Radiographic and clinical results were assessed preoperatively and at the final follow-up. Results The average operative time was 201.9 min and the mean blood loss was 817.5 ml. The visual analogue scale (VAS) improved significantly from 6.7 preoperatively to 1.1 at the final follow-up. The average correction of the segmental kyphosis at the level of the pseudarthrosis was 22.3°. Bony fusion was achieved in all patients, and there was no obvious loss of correction at follow-up. Conclusion Transpseudarthrosis osteotomy at the level of the pseudarthrosis can be safely performed and surgical repair of pseudarthrosis with interbody fusion by a single posterior approach was feasible.
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18
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Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes. J Orthop Trauma 2017; 31 Suppl 4:S57-S74. [PMID: 28816877 DOI: 10.1097/bot.0000000000000953] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Spinal ankylosing disorders encompass ankylosing spondylitis (AS), disseminated hyperostosis of the spine, and end-stage spondylosis. All these result in a stiffened and frequently deformed spinal column. This makes the spinal column highly susceptible to severe injuries that are commonly associated with unfavorable outcomes. Improved understanding of the underlying disease processes and clinical comorbidities may alter the poor injury related morbidity and mortality outcomes. METHODS A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 2001 and 2016: "ankylosing spondylitis," "epidemiology," "DISH," "treatment," "outcome," and/or "fracture." Articles were read for data on methodology (retrospective vs. prospective), type of treatment, number of patients, mean patient age, and mean follow-up. RESULTS Twenty-one identified articles were analyzed. Average age was 63.4 years. Most patients were men. Ground level fall or low energy trauma caused most injuries. Diagnosis was delayed in 15%-41% cases. Hyperextension fracture patterns were most common. Cervical spine fractures were more common than thoracolumbar fractures, with the highest prevalence between C5 and C7. Neurologic deficits were encountered in 21%-100% of patients. Operative fixation and fusion were performed in 40%-100% of patients. Mortality was reported between 0% and 32% at 1 year postinjury. Complications were encountered in 84% of patients, mostly in the form of pneumonia, respiratory failure, and pseudoarthrosis. Neurologic deterioration has been reported in 16% of patients. Fusion was successful in 87%-100% of patients. Neurologic deficits improved in function in 6%-66% at the final follow-up. CONCLUSIONS Because of the stiffening of the spinal column, patients with spinal ankylosing disorders are preferably evaluated for spinal fractures and ligamentous injuries after even trivial trauma. Spinal injuries in patients with AS are difficult to diagnose on plain radiographs; computed tomography and magnetic resonance imaging are recommended instead. The entire spine should be scanned for multilevel involvement. Although osteoporosis makes fixation of spine implants a significant concern, the literature has reported that most patients with AS treated surgically had good outcomes. Numerous studies have reported risks associated with conservative management.
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Puvanesarajah V, Cancienne JM, Shimer AL, Shen FH, Hassanzadeh H. Complications after Fusion for Thoracolumbar Fractures in Patients with Ankylosing Spondylitis. Global Spine J 2017; 7:28-32. [PMID: 28451506 PMCID: PMC5400163 DOI: 10.1055/s-0036-1583175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/08/2016] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Retrospective analysis of a Medicare database (2005 to 2012). OBJECTIVE To study postoperative complication rates following thoracolumbar fusion for traumatic thoracolumbar fracture in patients with ankylosing spondylitis (AS) compared with patients without AS. METHODS The PearlDiver database (2005 to 2012) was queried to examine postoperative complication rates in patients with AS undergoing posterior thoracolumbar fusion for thoracolumbar fracture (n = 968). Complication rates were compared with proportion-matched controls without AS undergoing the same procedure (n = 1,979). We examined and compared the incidence of death, postoperative infection, transfusion, venous thromboembolism, respiratory failure, pneumonia, myocardial infarction, urinary tract infection, and acute renal failure in each cohort within 90 days postoperatively. RESULTS Patients with AS had significantly higher rates of surgical site infection (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2 to 2.2, p = 0.002), day-of-surgery transfusion rates (OR 1.5, 95% CI 1.3 to 1.8, p < 0.0001), respiratory failure (OR 1.8, 95% CI 1.3 to 2.5, p = 0.0006), pneumonia (OR 1.8, 95% CI 1.3 to 2.5, p = 0.0002), acute renal failure (OR 1.6, 95% CI 1.2 to 2.3, p = 0.005), and total medical complications (OR 1.5, 95% CI 1.2 to 1.9, p < 0.0001). Ninety-day mortality was not different between the two cohorts (p = 0.18). CONCLUSIONS Thoracolumbar fusion for thoracolumbar fracture in patients with AS is associated with increased rates of surgical site infection, transfusion, respiratory failure, pneumonia, and acute renal failure postoperatively compared with patients without AS. The level of evidence in this study was III.
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Affiliation(s)
- Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jourdan M. Cancienne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Adam L. Shimer
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Francis H. Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States,Address for correspondence Francis H. Shen, MD, Department of Orthopaedic Surgery, University of Virginia, Box 800159 HSC, Charlottesville, VA 22908, United States (e-mail: )
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States
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20
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Does the Traversing Length of the Aorta Change After Closing Wedge Osteotomy for Ankylosing Spondylitis Patients With Thoracolumbar Kyphosis?: A Magnetic Resonance Imaging Investigation. Spine (Phila Pa 1976) 2017; 42:106-112. [PMID: 27398895 DOI: 10.1097/brs.0000000000001781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective magnetic resonance imaging (MRI) study. OBJECTIVE To investigate the change in aortic traversing length in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) after closing wedge osteotomy (CWO). SUMMARY OF BACKGROUND DATA The CWO has been widely adopted for the correction of thoracolumbar kyphosis caused by AS. During this procedure, the aorta may be elongated in the instrumented area, which implies a potential risk of the aortic injury. To date, no reports have been specifically published using MRI to investigate the alteration in aortic traversing length in patients with AS undergoing CWO. METHODS From June 2013 to July 2015, 24 patients with AS with thoracolumbar kyphosis with a mean age of 38.1 years were recruited in the present study. All patients underwent single-level CWO. MRI examinations were performed before and 2 weeks after surgery. For each subject, the aortic diameter and length were measured on the MRI. Radiographic measurements included the global kyphosis, thoracic kyphosis, lumbar lordosis, local kyhosis, angle of fusion levels, and anterior height of the osteotomized vertebra. The height of these patients was also recorded. RESULTS The aortic traversing length significantly increased by an average of 2.0 cm after surgery. Significant changes in height, global kyphosis, lumbar lordosis, local kyphosis, and angle of fusion levels were observed (P < 0.01), whereas the anterior height of the osteotomized vertebra was comparable before and after surgery (P > 0.05). In addition, the correlation analysis revealed a significant correlation between the aortic traversing length and changes in global kyphosis, lumbar lordosis, local kyphosis, angle of fusion levels, and height (P < 0.01). CONCLUSION The stretch of the aorta after CWO for the correction of thoracolumbar kyphosis was quantitatively verified by MRI investigation in the present study. Spine surgeons should be aware of the potential vulnerability of aortic injury in patients with AS undergoing CWO. LEVEL OF EVIDENCE 4.
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Liu H, Qian BP, Qiu Y, Wang Y, Wang B, Yu Y, Zhu ZZ. Vertebral body or intervertebral disc wedging: which contributes more to thoracolumbar kyphosis in ankylosing spondylitis patients?: A retrospective study. Medicine (Baltimore) 2016; 95:e4855. [PMID: 27661026 PMCID: PMC5044896 DOI: 10.1097/md.0000000000004855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Both vertebral body wedging and disc wedging are found in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis. However, their relative contribution to thoracolumbar kyphosis is not fully understood. The objective of this study was to compare different contributions of vertebral and disc wedging to the thoracolumbar kyphosis in AS patients, and to analyze the relationship between the apical vertebral wedging angle and thoracolumbar kyphosis.From October 2009 to October 2013, a total of 59 consecutive AS patients with thoracolumbar kyphosis with a mean age of 38.1 years were recruited in this study. Based on global kyphosis (GK), 26 patients with GK < 70° were assigned to group A, and the other 33 patients with GK ≥ 70° were included in group B. Each GK was divided into disc wedge angles and vertebral wedge angles. The wedging angle of each disc and vertebra comprising the thoracolumbar kyphosis was measured, and the proportion of the wedging angle to the GK was calculated accordingly. Intergroup and intragroup comparisons were subsequently performed to investigate the different contributions of disc and vertebra to the GK. The correlation between the apical vertebral wedging angle and GK was calculated by Pearson correlation analysis. The duration of disease and sex were also recorded in this study.With respect to the mean disease duration, significant difference was observed between the two groups (P < 0.01). The wedging angle and wedging percentage of discs were significantly higher than those of vertebrae in group A (34.8° ± 2.5° vs 26.7° ± 2.7°, P < 0.01 and 56.6% vs 43.4%, P < 0.01), whereas disc wedging and disc wedging percentage were significantly lower than vertebrae in group B (37.6° ± 7.0° vs 50.1° ± 5.1°, P < 0.01 and 42.7% vs 57.3%, P < 0.01). The wedging of vertebrae was significantly higher in group B than in group A (50.1° ± 5.1° vs 26.7° ± 2.7°, P < 0.01). Additionally, correlation analysis revealed a significant correlation between the apical vertebral wedging angle and GK (R = 0.850, P = 0.001).Various disc and vertebral wedging exist in thoracolumbar kyphosis secondary to AS. The discs wedging contributes more to the thoracolumbar kyphosis in patients with GK < 70° than vertebral wedging, whereas vertebral wedging is more conducive to the thoracolumbar kyphosis in patients with GK ≥ 70°, indicating different biomechanical pathogenesis in varied severity of thoracolumbar kyphosis secondary to AS.
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Affiliation(s)
- Hao Liu
- Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing
| | - Bang-Ping Qian
- Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing
- Correspondence: Bang-Ping Qian, Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Zhongshan Road 321, Nanjing 210008, China (e-mail: )
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing
| | - Yan Wang
- Department of Orthopedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Bin Wang
- Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing
| | - Yang Yu
- Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing
| | - Ze-Zhang Zhu
- Department of Spine Surgery, The Affiliated Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing
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Percutaneous stabilization of a T9/10 fracture in a patient with ankylosing spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 24 Suppl 8:S953-4. [PMID: 26601986 DOI: 10.1007/s00586-015-4329-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Narváez JA, Hernández-Gañán J, Isern J, Sánchez-Fernández JJ. Rheumatic diseases of the spine: imaging diagnosis. RADIOLOGIA 2016; 58 Suppl 1:35-49. [PMID: 26908249 DOI: 10.1016/j.rx.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/15/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning.
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Affiliation(s)
- J A Narváez
- Sección de Radiología Músculo-Esquelética, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España.
| | - J Hernández-Gañán
- Sección de Radiología Músculo-Esquelética, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | - J Isern
- Sección de Radiología Músculo-Esquelética, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | - J J Sánchez-Fernández
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
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El Tecle NE, Abode-Iyamah KO, Hitchon PW, Dahdaleh NS. Management of spinal fractures in patients with ankylosing spondylitis. Clin Neurol Neurosurg 2015; 139:177-82. [DOI: 10.1016/j.clineuro.2015.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/02/2015] [Accepted: 10/11/2015] [Indexed: 11/16/2022]
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Ghasemi-rad M, Attaya H, Lesha E, Vegh A, Maleki-Miandoab T, Nosair E, Sepehrvand N, Davarian A, Rajebi H, Pakniat A, Fazeli SA, Mohammadi A. Ankylosing spondylitis: A state of the art factual backbone. World J Radiol 2015; 7:236-252. [PMID: 26435775 PMCID: PMC4585948 DOI: 10.4329/wjr.v7.i9.236] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 05/12/2015] [Accepted: 06/15/2015] [Indexed: 02/06/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.
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