Biomechanical influence of the surgical approaches, implant length and density in stabilizing ankylosing spondylitis cervical spine fracture

Liu, Yaoyao; Wang, Zhong; Liu, Mingyong; Yin, Xingtian; Liu, Jiming; Zhao, Jianhua; Liu, Peng

doi:10.1038/s41598-021-85257-8

Cited by 13 publications

(16 citation statements)

References 69 publications

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“…For patients with impaired cervical stability and neurological deficit, surgery is a better treatment option. Especially for cervical fractures in AS patients, surgery has been widely recommended and used 13–16 . The procedures had been described including anterior approach, posterior approach, and combined approach, and the surgical procedures in relation to classification were analyzed as described below.…”

Section: Discussionmentioning

confidence: 99%

“…For this condition, Kouyoumdjian et al 20 suggested that anterior plate fixation should provide sufficient stability as long as the hardware is long enough to avoid significant moment arms. In a biomechanical study about surgical selection in stabilizing ASCST, researchers recommended that for patients who can only undergo anterior fixation, three‐level fixation could be more reliable 16 …”

Section: Discussionmentioning

confidence: 99%

“…In one of our previous studies, 13 we also confirmed that surgery by single PA could help to reduce the degree of fracture dislocation (mean 2.05 mm) and restore neurological function (31.03%) for treating CSF in AS patients. Although surgery by single PA may have a certain degree of risk of implant failure, from the biomechanical point of view, longer fixation could be stable enough, and three‐level posterior fixation might be the most cost‐effective option 16 . In brief, surgery by PA could treat most trauma types of our novel classification.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

Liu

Yang

et al. 2023

Orthopaedic Surgery

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Objective: Currently, there are no reports on the specific classification of cervical spine trauma (CST) in ankylosing spondylitis (AS) based on the trauma mechanism. In this study, we aimed to describe a novel classification of CST in AS with more details, and put forward the corresponding surgical outcomes related to different types, hoping to provide a practical reference for clinical decision-making and academic communication.Methods: From January 2008 to December 2021, AS patients who experienced CST were retrospectively reviewed and included. Clinical data including gender, age, reason of trauma, time interval between AS diagnosis and trauma were collected. The American Spinal Injury Association (ASIA) grade system was used to describe patients' neurological status. Based on the combination of surgical experience and follow-up observation, the lower cervical spine trauma in AS patients was divided into three main types, namely single level fracture-dislocation (type 1), spinal cord injury without fracturedislocation (type 2), and Andersson lesion (type 3). Furthermore, we performed detailed subtypes according to whether cervical spine was completely fused and the location of injury. Meanwhile, according to different approaches, surgical methods mainly included Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), Posterior Expansive Open-door Cervical Laminoplasty (PEOLP), Posterior Cervical Laminectomy Decompression and Fusion (PCLDF), and their combination. Postoperative general and surgery-related complications were also recorded.Results: A total of 102 patients were enrolled, including 91 males and 11 females, with an average age of 51.9 years. Their average interval time between AS diagnosis and injury was 27.8 years. Patients with high-energy and low-energy trauma were 54 and 48 respectively. There were 79 patients suffering spinal cord nerve impairment after trauma. With regard to the distribution of different types, the number of patients in type 1, type 2, and type 3 were 86, 14, and two, respectively. For different types, PCLDF was the most commonly used surgical method, accounting for 55.9%, while ACCF was only applied for one time. In type 1, the frequencies of ACDF, ACCF, PCLDF, and ACDF +PCLDF were 10.5%, 1.2%, 55.8%, and 32.5%. In type 2, the frequencies of ACDF, PCLDF, ACDF+PCLDF, and PEOLP were 7.1%, 50.0%, 7.1%, 35.8%. Postoperatively, 21 patients achieved neurological function improvement. The incidences of general and surgery-related complications were 19.6% and 5.9%, respectively. All patients achieved bone fusion and durable decompression at the last follow-up.Conclusions: Our novel classification could enrich the scope of CST in AS patients and provide valuable references to the corresponding clinical management. Besides, there are strict indications of different surgical methods, factors like patient's physical condition, trauma type, surgical purpose, and expected efficacy were all required to consider before making a clinical decision.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

Liu

Yang

et al. 2023

Orthopaedic Surgery

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“…Patients with AS are more susceptible to spinal fractures, especially cervical fractures [2] . That is because of the ossification of the intervertebral discs and supportive tissues [1] , [10] . Also, in patients with AS, cervical fractures are considered unstable, resulting in neurological deficits; so, surgical management is the treatment of choice for this condition [2] .…”

Section: Discussionmentioning

confidence: 99%

Odontoid fracture complicating ankylosing spondylitis presenting with cervical canal stenosis and quadriparesis: A case report with 5-year follow-up and review of the literature

Eghbal

Kamran

Salimi

et al. 2022

International Journal of Surgery Case Reports

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“…When the injury compresses the cervical cord or peripheral nerves, the clinical treatment is usually performed by internal xation via screws to restore stability, including internal xation via the pedicle, the articular process, or the vertebral plate [4][5][6] . Currently, most studies on lower cervical internal xation have focused on its stability from the biomechanical point of view but less from the anatomical point of view of the vertebrae themselves [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Exploring the Micromorphological Characteristics of Adult Lower Cervical Vertebrae Based on Micro-computed Tomography

Yang

Wang

et al. 2023

Preprint

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Objective: we will use micro-computed tomography to scan the adult lower cervical vertebrae and measure structural and morphological parameters. Then we will analyze the data, summarize trabecular distributing patterns, and provide the anatomical theoretical basis for clinical and surgical treatment strategies. Methods: Micro-computed Tomography scans were performed on 31 sets of lower cervical vertebrae (155 vertebrae) to observe the morphological characteristics and direction of trabeculae in the lower cervical vertebrae by outlining and reconstructing the regions of interest and to calculate the variation laws of the microstructure in the regions of interest to reveal their structural characteristics and weak areas. Results: The images showed that the trabeculae in the lower cervical pedicle near the medial and lateral cortices were relatively dense, and their bone plates were lamellar. There were cavities between the superior and inferior articular processes where the ossification centers had not been absorbed after ossified. The lamellar trabeculae in the vertebral plates near the cortical bones were only 1-2 layers, extended and transformed into rod-shaped trabeculae in a radial shape toward the medullary space. The lamellar trabeculae of the vertebral plate extend over the spinous process near the cortical bone. The statistical results of the trabeculae's morphological parameters showed significant differences in bone volume fraction values among the four parts (P<0.05). There were substantial differences in BS/BV, except for no differences between the pedicle and the vertebral plate (P<0.05). There was a significant difference in trabecular pattern factor values between the articular process, the spinous process, and the vertebral plate (P<0.05) and a significant difference between the pedicle, the spinous process, and the vertebral plate (P<0.05). There were no significant differences in trabecular bone thickness and trabecular space values among the four parts (P<0.05). Conclusion: The anatomical microstructural perspective confirms that the optimal choice is internal fixation via the pedicle. If using pedicle screws, the nail tract needs to be placed into the spinous process to increase its holding power and resistance to extraction.

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Biomechanical influence of the surgical approaches, implant length and density in stabilizing ankylosing spondylitis cervical spine fracture

Cited by 13 publications

References 69 publications

A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

Odontoid fracture complicating ankylosing spondylitis presenting with cervical canal stenosis and quadriparesis: A case report with 5-year follow-up and review of the literature

Exploring the Micromorphological Characteristics of Adult Lower Cervical Vertebrae Based on Micro-computed Tomography

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