Management of spinal fractures in patients with ankylosing spondylitis

Tecle, Najib E. El; Abode-Iyamah, Kingsley; Hitchon, Patrick W.; Dahdaleh, Nader S.

doi:10.1016/j.clineuro.2015.10.014

Cited by 46 publications

(55 citation statements)

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“…AS usually starts before 30 years of age, manifested as chronic pain and stiffness of the low back. With age, loss of spinal mobility and chest expansion, extension of the lumbar spine becomes evident [3, 4], resulting in severe disability in AS patients [1]. It was reported that AS affects between 0.5 and 14 per 100,000 people every year [5].…”

Section: Introductionmentioning

confidence: 99%

Genome-wide DNA methylation profile analysis identifies differentially methylated loci associated with ankylosis spondylitis

Hao

Yang²,

et al. 2017

Arthritis Res Ther

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BackgroundAnkylosing spondylitis (AS) is a chronic rheumatic and autoimmune disease. Little is known about the potential role of DNA methylation in the pathogenesis of AS. This study was undertaken to explore the potential role of DNA methylation in the genetic mechanism of AS.MethodsIn this study, we compared the genome-wide DNA methylation profiles of peripheral blood mononuclear cells (PBMCs) between five AS patients and five healthy subjects, using the Illumina Infinium HumanMethylation450 BeadChip. Quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was performed to validate the relevance of the identified differentially methylated genes for AS, using another independent sample of five AS patients and five healthy subjects.ResultsCompared with healthy controls, we detected 1915 differentially methylated CpG sites mapped to 1214 genes. The HLA-DQB1 gene achieved the most significant signal (cg14323910, adjusted P = 1.84 × 10–6, β difference = 0.5634) for AS. Additionally, the CpG site cg04777551 of HLA-DQB1 presented a suggestive association with AS (adjusted P = 1.46 × 10–3, β difference = 0.3594). qRT-PCR observed that the mRNA expression level of HLA-DQB1 in AS PBMCs was significantly lower than that in healthy control PBMCs (ratio = 0.48 ± 0.10, P < 0.001). Gene Ontology (GO) and KEGG pathway enrichment analysis of differentially methylated genes identified four GO terms and 10 pathways for AS, functionally related to antigen dynamics and function.ConclusionsOur results demonstrated the altered DNA methylation profile of AS and implicated HLA-DQB1 in the development of AS.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1382-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Genome-wide DNA methylation profile analysis identifies differentially methylated loci associated with ankylosis spondylitis

Hao

Yang²,

et al. 2017

Arthritis Res Ther

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“…Although there is evidence to suggest that, like AS patients, patients with spinal ankylosis due to DISH are also at risk for unstable fractures of the spine, we realized that the awareness of DISH is much lower among clinicians. 6,7 Treatment of spinal fractures in the ankylosed spine is controversial. There are several reports on nonsurgical treatment that describe it as safe compared to operative management, due to the higher morbidity and mortality rates of the latter.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Fractures of the Ankylosed Spine

et al. 2020

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Objective: We aim to identify retrospectively surgically treated patients with an ankylosed spine who sustained a vertebral fracture. Our goal is to evaluate the main outcomes and complications. Methods: We selected patients through the database of surgical interventions in the setting of fractures of an ankylosed spine segment between January 1st 2008 and June 30th 2018. We collected data from digital medical records. The parameters analyzed include hospital length of stay, Intensive Care Unit (ICU) admission, perioperative and postoperative complications as well as neurological evolution. Results: Fractures occurred in 14 patients with ankylosing spondylitis (82%) and 3 patients with diffuse idiopathic skeletal hyperostosis (18%). All patients were male and the mean age was 69 years. Fourteen fractures occurred after minor trauma (83%), of which 11 were due to falls from standing height or lower (65%). The cervical spine represents the majority of the levels involved (65%). Seven patients were admitted to the ICU (41%) and 11 suffered neurological damage. There was improvement of neurological status in less than 50% and there were high percentages of post-operative complications. Conclusion: Patients with ankylosed spine diseases are at higher risk for vertebral fracture, even after minor trauma, and these are located predominantly in the cervical spine. The surgical treatment of these conditions is effective as it allows improvement of the patient's neurological status. However, they still present higher morbidity and mortality, as well as increased post-op complications. Prevention of falls may drastically change patients' outcome, neurological function and independence in activities of daily living. Level of evidence IV; A case series therapeutic study. RESUMOObjetivo: Identificar retrospetivamente casos de tratamento cirúrgico de fraturas vertebrais em pacientes com coluna anquilosada. O nosso propósito consiste em avaliar os principais desfechos e respectivas complicações. Métodos: Selecionamos pacientes através do banco de dados de intervenções cirúrgicas no quadro de fraturas de um segmento da coluna anquilosada entre 1 de janeiro de 2008 a 30 de junho de 2018. Coletamos os dados a partir dos prontuários médicos digitais. Os parâmetros analisados incluem período de internação hospitalar, admissão na Unidade de Tratamento Intensivo (UTI), complicações pré-e pós-operatórias, assim como evolução neurológica. Resultados: As fraturas ocorreram em 14 pacientes com espondilite snquilosante (82%) e em 3 pacientes com hiperostose esquelética difusa idiopática (18%). Todos os pacientes eram do sexo masculino e a idade média era de 69 anos. Quatorze fraturas ocorreram devido a trauma menor (83%), das quais 11 eram devido a quedas da própria altura ou inferiores (65%). A coluna cervical representa a maioria dos níveis envolvidos (65%). Sete pacientes foram admitidos na UTI (41%) e 11 sofreram lesão neurológica. Houve melhoria do estado neurológico em menos de metade dos pacientes e altas porcentagens de complicações...

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“…[8–10] When the symptom of cervical spine instability and neurological impairments is observed in these patients, surgery is highly regarded as the efficient treatment method for these patients. [14,15] …”

Section: Introductionmentioning

confidence: 99%

“…[11–13] The common surgical approaches for cervical spine fracture mainly include simple anterior approach alone, posterior approach alone, and combined anterior–posterior approach. [14,15] Due to the extensive osteoporosis in spine of AS patients, it is very challenging for the surgery to avoid the second injury of spinal cord and the severe complications no matter which surgical approach adopted. [11–16] Generally, cervical fracture appears to be unstable Chance fracture, often affecting anterior, middle, and posterior column (3-column) with high probability of dislocation, neurological impairment.…”

Section: Introductionmentioning

confidence: 99%

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One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach

Xie

Cai

et al. 2017

Medicine

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The aim of the article is to investigate the efficacy and safety of 1-stage surgical therapy via combined anterior–posterior approach on cervical spine fracture in patients with ankylosing spondylitis (AS).We retrospectively analyzed profiles of 12 AS patients with severe fracture-dislocation of cervical spine received 1-stage combined anterior–posterior surgery in our hospital from October, 2013, to October, 2015, including clinical characteristics, follow-up data, and imaging records. We compared the parameters before and after surgery on the basis of neurological function, bone fusion, Cobb angles of operation segment, Barthel index (BI) score, and incidence rate of complications.A total of 12 patients received 1-stage surgery via combined anterior–posterior approach within 3 days after injury. No severe complications and death occurred. All patients received the successfully anatomical reduction of fracture-dislocation, in which 9 achieved function restoration. The latest follow-up showed the neurological function status of patients was improved. The Cobb angles of operation segments were recovered; the rate of bone fusion was 66.7% at 3 months and 100% at 6 months post-operation. The BI score was improved, 4 cases of moderate dependence and 8 of slight dependence at the latest follow-up compared to 10 of severe dependence and 2 of moderate dependence preoperation. In no cases did severe complications from implanted instrumentation occur.It was high efficacy and safety that the surgical therapy was performed on cervical fracture-dislocation in AS patients by the 1-stage combined anterior–posterior approach. The key of the surgery is the robust stabilization and full decompression of fracture spine at early stage. In addition, if spinal anatomical reduction of fracture segments is difficult to be achieved, the functional restoration should be adopted during the surgery.

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Management of spinal fractures in patients with ankylosing spondylitis

Cited by 46 publications

References 45 publications

Genome-wide DNA methylation profile analysis identifies differentially methylated loci associated with ankylosis spondylitis

Genome-wide DNA methylation profile analysis identifies differentially methylated loci associated with ankylosis spondylitis

Surgical Treatment of Fractures of the Ankylosed Spine

One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach

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