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

Abstract

■ Describe the imaging features and altered biomechanics of various rigid spine entities. ■ Characterize the injury patterns of a rigid spine at CT and MRI and the findings that may prompt surgical intervention. ■ Recognize the causes of delay in diagnosing a rigid spine injury, its impact on outcomes, and how it can be prevented.

Imaging features of spinal fractures in ankylosing spondylitis and the diagnostic value of different imaging methods

“…MRI is particularly valuable in showing neurological, disco-ligamentous, and soft tissue injuries. The prevalence of spinal cord injury in AS patients is more than 11 times greater than in the general population (3). Several studies have shown a markedly higher prevalence of neurological complications ranging from 33% to 58% for thoracic and lumbar fractures and even higher cervical spine rates (24).…”

“…The incidence of spinal fracture in patients with AS is 7-8 times higher than in normal subjects (3,4). AS patients with spinal fracture characteristics differ from other patients, and fractures often involve three columns of the spine and are more easily associated with a dislocation.…”

Imaging update in spondyloarthropathy

“…Thirdly, kyphotic deformities are common in AS, shifting the centre of gravity anteriorly, increasing the shear stress forces. 34 Early diagnosis and treatment may prevent disease burden of ankyloses and subsequent complex spinal fractures with significant associated morbidity. 35 The most common mechanism for injury in patients with AS is reported as hyperextension, causing transverse fracture through the intervertebral disc space, due to the calcified disc being the weakest point along the ankylosed spine, with cervical fractures being more common than those of the thoracolumbar spine.…”

“…In the majority of these cases the cervical and thoracic spine are affected, followed by cases affecting the thoracic and lumbar regions. 34 One study demonstrated that in the majority of patients with AS, complicated by spinal fracture, sustained three-column fractures, identified on CT. Of the patients in the study who underwent MRI, 36% demonstrated spinal cord injury, 59% saw vertebral fracture accompanied by BMO of the vertebral body and 31% had injury of the posterior ligamentous complex (PCL). 36 There is little consensus on whether CT alone, or MRI in addition, should be performed in the context of trauma in AS however multiple sources advocate performing whole spine CT to look for multiple non-contiguous fractures, whilst having a low threshold for MRI spine for assessment of the PCL and spinal cord.…”

“…36 There is little consensus on whether CT alone, or MRI in addition, should be performed in the context of trauma in AS however multiple sources advocate performing whole spine CT to look for multiple non-contiguous fractures, whilst having a low threshold for MRI spine for assessment of the PCL and spinal cord. 34,35,37 One study found that when comparing spinal trauma patients with AS against those with DISH, MRI spine in AS patients, with CT confirmed vertebral body fracture, demonstrated posterior element injury in 71% of patients. These findings were considered to have clinical implications, with these AS patients undergoing surgical treatment, despite having no neurological deficit.…”