Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

Abstract

The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010-2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI admitted cases), with an average age of 54.6 years (median 56, limits 42-73 years). The average duration between the medically diagnosed AS and the actual associated spinal fracture(-s) moment was 21.4 years (median 23; limits 10-34 years). Low-energy trauma was incriminated in 54.5% cases. The spinal level of fracture was: cervical (four cases), thoracic (three), lumbar (four), assessed at admission as: American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (four subjects), C (five) and D (two). By the time of discharge, neither patient has neurologically deteriorated; five patients (45.5%) improved of at least grade 1 (AIS). The overall complications were mainly infections: symptomatic urinary tract infections (seven patients; 63.6%), pulmonary (three subjects; 27.3%) and spondylodiscitis (one case; 9%). The average follow-up period was 15.3 months (median 12; limits 1-48 months) after discharge; three subjects gained functional improvement to AIS-E. The clinical profile (different risk factors, mechanisms, types and levels of spinal fractures, additional encephalic and/or cord lesions, co-morbidities), different post-surgical and/or general complications acquired during admission in our rehabilitation ward, served us for future prevention strategies and a better therapeutic management.

Traumatic versus non traumatic spinal cord injury: Characteristics and functional outcome in a Tunisian rehabilitation centre

“…Traumatic SCI affect more young adults. In our study, mean age of patients in T group was 34 years (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). However a remarkable increase of traumatic SCI incidence is noticed in older population [9,10].…”

“…The prognosis is better for partial lesions in young patients and in the absence of severe associated comorbidity or late complications. The prevention and early diagnosis improve the treatment results is both types of SCI [22].…”

Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

“…22,23 Ankylosing spondylitis with a spinal fracture is most common in the cervical spine easy to complicate cervical spinal cord injury, and leads to serious nerve injury in patients. 24,25 The diagnosis of ankylosing spondylitis combined with cervical spine fracture is a significant issue that cannot be overlooked. Most cases of ankylosing spondylitis combined with cervical spine fracture are caused by minor trauma.…”

“…22,23 Ankylosing spondylitis with a spinal fracture is most common in the cervical spine easy to complicate cervical spinal cord injury, and leads to serious nerve injury in patients. 24,25…”

Injuries to the Rigid Spine: What the Spine Surgeon Wants to Know

“…This and other pathophysiologic changes lead to classic imaging signs depicted on radiographs as detailed in Table 2 (14). The facet joints are also affected in AS by capsular enthesitis, which causes ossification in a bony shell-enclosing pattern (15).…”