Multiple Spine Fractures in Ankylosing Spondylitis

Osgood, Carroll P.; Abbasy, Munir; Mathews, Thomas

doi:10.1097/00005373-197502000-00011

Cited by 48 publications

(25 citation statements)

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“…11 Multiple non-contiguous vertebral fractures have been well recognized in ankylosing spondylitis. 12,13 This incidence in the normal spine is reported to be from 4 ± 8%. 14 Their incidence is unknown in the ankylosing spondylitis population.…”

Section: Discussionmentioning

confidence: 98%

Occult vertebral fractures in ankylosing spondylitis

1999

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Study Design: A retrospective review of patients with ankylosing spondylitis involved in blunt trauma. Setting: Patients referred to two Level I trauma centers. Objectives: To determine the incidence and clinical sequelae in this patient population where vertebral injury was diagnosed on a delayed basis. Summary of Background Data: The ankylosed spine is at increased risk for fracture and spinal cord injury. Radiological identi®cation of injury is more di cult than in the normal spine. Results: Over a 5 year period, 21 patients were identi®ed with seven having an occult vertebral fracture not recognized as the primary injury or occurring as a second noncontiguous injury level. In these cases, delay in diagnosis of the occult injury was from 3 to 22 days. Development of secondary neurological de®cits occurred in three patients. Conclusions: A high index of suspicion and an appreciation of the extreme instability of a fracture in ankylosing spondylitis must be present.

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Section: Discussionmentioning

confidence: 98%

Occult vertebral fractures in ankylosing spondylitis

1999

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“…Particular care should be given to maintaining alignment during radiography and surgery. As has been previously pointed out by Osgood et al (1975) and Woodruff and Dewing (1963), these are 'long bone' fractures. Excessive traction will cause separation of the fractured segments.…”

Section: Principles Of Managementmentioning

confidence: 80%

“…The authors share with Osgood et al (1973Osgood et al ( , 1975 and Rand and Stern (1961) a number of important management principles. As previously stated, we wish to re-emphasise the need to maintain a high index of diagnostic suspicion.…”

Section: Principles Of Managementmentioning

confidence: 99%

“…Freeman (1961), Kuhn and Garrett (1972), Rogers (1957), Nickel et al (1968 and Stauffer (1975) have advocated use of the halo. We share with Osgood et al (1973Osgood et al ( , 1975 external fixation for the fractured spondylitic spine. Internal fixation is seldom indicated and is fraught with the surgical hazards associated with these high-risk patients.…”

Section: Principles Of Managementmentioning

confidence: 99%

“…Stiasny (1933) reported the first case of cervical spinal cord injury associated with ankylosing spondylitis and made three important observations: delayed onset and diagnosis, the absence of major neuro logical change and a rapid bony consolidation. Subsequently, a number of cases have been reported by authors such as Bergmann (1949), Cheshire (1969), Hollin et al (1965), Guttmann (1966), Symonds (1953), Hughes and Brownell (1963), Woodruff and Dewing (1963), Osgood et al (1973Osgood et al ( , 1975, Rand and Stern (1961).…”

Section: Introductionmentioning

confidence: 98%

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Cervical ankylosis with acute spinal cord injury

et al. 1977

Spinal Cord

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Abstract.Twenty-three cases of acute spinal cord injury in persons with cervical ankylosis are presented. Certain characteristics of major sub-groups are described:ankylosing spondylitis (N = 8), degenerative spondylosis (N = 9) and congenital fusion (congenital non-segmentation) (N = 6). The ankylosing spondylitic group presented a grim prognosis for survival (death rate 50 per cent within 60 days) and for loss of neuro logical function. Five out of eight cases had permanent neurological loss subsequent to their injuries.Both the ankylosing spondylitic and degenerative spondylotic groups presented problems in diagnosis and medical management. The basic principle is immobilisation of the fracture and mobilisation of the patient. The halo is the technique of choice for fracture immobilisation. An integrated intensive respiratory management programme is essential. Patients with ankylosed spines, particularly those with ankylosing spondylitis, should be educated in simple measures to prevent fracture of their spines.

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Spinal Fractures Complicating Ankylosing Spondylitis

Hunter

Dubo

1983

Arthritis & Rheumatism

119

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Twenty-two spinal fractures in 20 patients with chronic ankylosing spondylitis are reported. Nineteen fractures occurred in the cervical region. Fourteen of the fractures were caused by minor falls, 3 by falls down steps, 4 by motor vehicle accidents, and 1 by cardiopulmonary resuscitation. Long-term followup (mean 3.2 years) of 9 fractures diagnosed early and managed conservatively showed bony union of all fractures. No patient deteriorated neurologically and 3 patients made maor recovery. Long-term followup is also reported on 6 patients in whom the diagnosis was delayed. The difficulties in diagnosis and management are discussed.In 1978 we reported 8 patients with chronic ankylosing spondylitis complicated by spinal fracture and we reviewed 56 patients previously reported in the English language literature (1). The experience from these small series gathered from a number of centers suggested that the ankylosed cervical region was the most common site of fracture, that minor trauma was the most common cause of the fracture, and that radiographic visualization of the fracture site may be difficult. We have now enlarged our experience to 22 spinal fractures in 20 patients with chronic ankylosing spondylitis. The purpose of this study is first, to determine whether the statements we made previously still hold true for a large series of patients from one center. Second, since we have conducted a clinical and radiographic followup of these patients, we are now able to report on the natural history of these fractures and the long-term results of conservative management. PATIENTS AND METHODSThe clinical records of all patients with ankylosing spondylitis complicated by spinal fractures, admitted to the Health Sciences Centre or St. Boniface General Hospital, Winnipeg between 1965 and 1982, were reviewed. Clinical and radiographic followup was then obtained.For the purpose of assessing the natural history of these fractures and the results of conservative management, the patients were divided into 2 groups. Group I consisted of patients in whom the diagnosis of spinal fracture was made immediately and conservative management instituted.Group I1 consisted of patients in whom the diagnosis of spinal fracture was delayed. RESULTSTwenty patients with ankylosing spondylitis had suffered fractures of the ankylosed spine. All the patients were male. The clinical data, including nature of the trauma, level and type of bony and neurologic injury, management, and results of long-term followup, are listed in Table 1 for Group I and Table 2 for Group 11. Two patients had suffered a second cervical fracture during the period of followup, and the details of these fractures are included.

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Multiple Spine Fractures in Ankylosing Spondylitis

Cited by 48 publications

References 0 publications

Occult vertebral fractures in ankylosing spondylitis

Occult vertebral fractures in ankylosing spondylitis

Cervical ankylosis with acute spinal cord injury

Spinal Fractures Complicating Ankylosing Spondylitis

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