Occult vertebral fractures in ankylosing spondylitis

Finkelstein, JA; Chapman, Jane; Mirza, Sohail K.

doi:10.1038/sj.sc.3100837

Cited by 118 publications

(82 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several authors have shown patients with ankylosing spondylitis (AS) to have a fourfold fracture risk during their lifetime compared to unaffected individuals [27,133]. In AS spontaneous fusion of the sacroiliac joints and spine occurs due to chronic inflammation leading to initial back pain followed by generalized stiffness of the spine.…”

Section: Introductionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

View full text Add to dashboard Cite

The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.

show abstract

Section: Introductionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

View full text Add to dashboard Cite

show abstract

“…El caso referido afecta a un varón, al igual que la mayoría de casos descritos en la literatura 7,10,12,20,22 . La gravedad del traumatismo se enfatiza por el hecho de que, en su 9,21 .…”

Section: Discussionunclassified

“…La mayor incidencia de déficits neurológicos secundarios en pacientes con fracturas vertebrales, inicialmente inadvertidas, es de gran importancia en pacientes con EA 2,7,8,13 , como en el caso que nos ocupa. El mecanismo lesional más frecuente en este tipo de lesiones es la hiperextensión-distracción (estadío 2 de Allen), produciendo fracturas transdiscales, mientras que el mecanismo flexor suele provocar fracturas a través del cuerpo vertebral (tipo Chance) 21,23 .…”

Section: Discussionunclassified

Fractura transdiscal y subluxación C5-C6 en paciente con espondilitis anquilopoyética

2006

View full text Add to dashboard Cite

ResumenLa fractura cervical es una posible complicación, no infrecuente, de la espondilitis anquilopoyética (EA) de larga evolución.La actual nota clínica recoge un caso registrado en nuestro hospital, consistente en una fractura transdiscal y luxación C5-C6, con paraplejia final residual.Su gravedad, pues, radica en su importante morbimortalidad en este tipo de pacientes.El presente artículo centra su atención sobre el diagnóstico precoz, que posibilitará un manejo terapéutico personalizado, y sobre la prevención, en la medida de lo posible, de esta grave complicación.Analizamos el contexto clínico del paciente, los factores predisponentes, el mecanismo lesional, la expresión radiológica, las secuelas neurológicas y el manejo terapéutico.PALABRAS CLAVE: Espondilitis anquilopoyética. Fractura cervical. Lesión neurológica. C5-C6 transdiscal fracture and subluxation in a patient with ankylosing spondylitis SummaryCervical fracture is not a rare complication of longterm ankylosing spondylitis (AS). We are reporting a case of cervical fracture in a patient affected by which was complicated by a transdiscal fracture, C5-C6 subluxation, and residual paraplegia.We analyse clinical presentation, predisponent factors, injury mechanism, radiologic features, neurological deficits, and terapeutic management.We discuss the accurate diagnosis and the most suitable treatment for this serious complication, as well as prevention measures.

show abstract

“…In den vorliegenden Fallbeschreibungen wurden in der initialen konventionellen Röntgendiagnostik nicht alle Verletzungsfolgen primär diagnostiziert. Erst die Hinzunahme der CT-und MRT-Untersuchungen erbrachte die vollständigen Diagnosen.Finkelstein et al [7] beobachteten in einem 5-Jahres-Zeitraum von 7 Patienten mit primär nicht diagnostizierten Frakturen der Wirbelsäule bei einer maximalen diagnostischen Verzö-gerung von 22 Tagen. Die in Kasuistik 2 beschriebenen Zervicobrachialgien sind ein häufig geschildertes Leitsymptom der Wirbelsäulenverletzung bei der ankylosierenden Spondylitis und sollten zu einer weiterführenden Diagnostik veranlassen [2,8,12].…”

Section: Der Unfallchirurg 2•2002 | 167unclassified

Behandlung der Wirbelsäulenfraktur bei ankylosierender Spondylitis

May¹,

Raunest²,

Herdmann

et al. 2002

Der Unfallchirurg

View full text Add to dashboard Cite

Clinical guidelines for the treatment of vertebral fractures associated with ankylosing spondylitis are derived from case reports and a review of literature. The coincidence of paravertebral calcifications and fracture formations leads to problems in the establishment of a proper initial diagnosis. Therefore computed tomography and magnetic resonance imaging have to be employed to define the extent of fracture and the presence of spinal lesions. As a rule vertebral fractures based upon spondylitic alterations are extremely unstable and tend to secondary dislocation with a high risk of spinal cord injuries. Operative osteosynthesis is the method of choice in the fracture treatment. A successful stabilization requires an extended spondylodesis comprising at least five vertebral segments by a dorsal or a combined ventral instrumentation.

show abstract

Occult vertebral fractures in ankylosing spondylitis

Cited by 118 publications

References 17 publications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Fractura transdiscal y subluxación C5-C6 en paciente con espondilitis anquilopoyética

Behandlung der Wirbelsäulenfraktur bei ankylosierender Spondylitis

Contact Info

Product

Resources

About