Cervical spine fracture prediction by simple plain X-ray in ankylosing spondylitis patients after low-energy trauma

Abstract

Background Due to various reasons, the diagnosis of cervical spine fracture (CSF) in patients with ankylosing spondylitis (AS) may be missed or delayed in clinical practice.Objective To explore the prediction ability of simple plain X-ray for the possibility of CSF in AS patients who suffer from low-energy trauma (LET).Methods From January 2010 to December 2019, AS patients who experienced LET were retrospectively reviewed. Their clinical data, including gender, age, body mass index, time interval between AS diagnosis and trauma, smoking or not, and a presence of continuous bony bridge between anterior margin of C1 and C2 body or not was collected. Besides, distances and angles were measured by the lateral cervical X-ray.Results 129 AS patients were divided into Fracture group (41 cases) and Non-fracture group (88 cases) based on whether CSF existed. A total of twelve parameters had significantly statistical differences between two groups (P < 0.05). According to the binary logistic regression model, four of the twelve parameters showed a further correlation with the occurrence of CSF after LET in AS patients, namely, mean Pavlov ratio (P < 0.001, OR = 0.067), Angle D (P = 0.031, OR = 1.057), Borden’s index (P = 0.042, OR = 1.131), the time interval between the AS diagnosis and the trauma (P < 0.020, OR = 0.935). Their 95% CI were (0.023 to 0.194), (1.005 to 1.112), (0.994 to 1.287), and (0.883 to 0.990), respectively. The ROC curve and the AUC further revealed the mean Pavlov ratio had the largest AUC (0.793) (95% CI: 0.873 to 0.986), whose cut-off value was 0.72 based on the highest Youden’s index value. The optimal cut-off value, sensitivity, and specificity of the other three parameters were Angle D (45.65°, 61.0%, 78.4%), Borden’s index (9.79, 87.8%, 37.5%), and the time interval between AS diagnosis and trauma (15.50 years, 70.7%, 56.8%).Limitations The number of the included patients in the present study was relatively small.Conclusions Four parameters measured by simple X-ray show prediction ability for the occurrence of CSF in AS patients who encounter LET.

Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report

“…In cases of cervical spine injuries in patients with ankylosing spondylitis, the combined anterior and posterior approach is the most preferred method for surgical treatment [17][18][19]. Liu et al typically employ a comprehensive approach to revise and restore the firm stability of the cervical spine [20]. In this case, the patient had a missing C5 vertebral body.…”