Neurological complications of ankylosing spondylitis

Abstract

Thirty-three patients with ankylosing spondylitis with or without spinal neurological symptoms requiring surgical intervention were identified in a retrospective review of all cases of spinal disorders treated at the Mayo Clinic during the period from 1984 to 1989. Spinal fractures (traumatic or pseudoarthroses), progressive spinal deformity, rotary instability secondary to atlanto-occipital or atlantoaxial subluxation, and spinal stenosis with associated neurological deficit, pain, or spinal instability were the most common indications for surgery. Of the 41 operations performed, there were 17 cervical, 14 thoracic, and 10 lumbar procedures. Eight patients had two or more disorders at separate spinal levels that required surgery. Preoperative neurological deficits were recorded in 13 patients; these improved following surgery in nine and stabilized in four. This review emphasizes the fragility of the ankylosed spinal column and its inherent susceptibility to fracture with attendant neurological compromise. It also identifies the variety of spinal disorders observed in these patients and discusses their surgical management. The experience with this series suggests that thorough radiological evaluation, extreme caution with endotracheal intubation and with halo-vest applications, early surgical spinal immobilization, and aggressive postoperative mobilization of patients are necessary for a successful outcome. It is concluded that outcomes in these patients can be favorable when managed appropriately.

Surgery of the deformities in ankylosing spondylitis: Our experience of lumbar osteotomies in 31 patients

“…The anterior ligament was calcified totally in 15 patients, only at the lumbar level in 13 [9], and was intact in 3. Lateral standing views were studied to assess hip flexion and the lateral aspect of the curvature, in particular to ascertain whether the curvature was a global thoracolumbar kyphosis systematically associated with a vertical sacrum (20 patients) or a double curvature with significant thoracic kyphosis and loss of lumbar lordosis (11 patients).…”

Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation

“…Surgery for unstable fractures in AS includes anterior/posterior decompression and fixation or both. Decompression, instrumentation, bone grafting, and various osteotomies for deformity correction have been reported and long segment fixation is usually preferred for fractures [1,3,[6][7][8], but surgical recommendations for AL are scarce.…”

Surgical Experience of Neglected Lower Cervical Spine Fracture in Patient with Ankylosing Spondylitis

“…In long-standing disease, ossification of the ligaments and joints of the involved spine occurs and leads to universal spinal syndesmophytosis. Spinal fractures are 3.5 times more common in AS patients than in the normal population 6) . Even in the face of minor external stress, the rigid and brittle fused spine is easily broken because of altered biomechanics, which leads to the spine behaving much like an osteoporotic long bone rather than an elastic spine 5,17) .…”

“…Even in the face of minor external stress, the rigid and brittle fused spine is easily broken because of altered biomechanics, which leads to the spine behaving much like an osteoporotic long bone rather than an elastic spine 5,17) . The lower cervical spine is especially prone to such injuries because the protecting muscle is weak and the supporting paravertebral soft tissues are ossified 6,14,16) . Fractures tend to occur at the level of the intervertebral disc as a result of incomplete ossification of the nucleus pulposus, often allowing displacement 11) .…”