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

Wang

et al. 2021

Sci Rep

Ankylosing spondylitis cervical spine fractures (ASCFs) are particularly unstable and need special consideration when selecting appropriate internal fixation technology. However, there is a lack of related biomechanical studies. This study aimed to investigate the biomechanical influence of the pattern, length, and density of instrumentation for the treatment of ASCF. Posterior, anterior, and various combined fixation approaches were constructed using the finite element model (FEM) to mimic the surgical treatment of ASCFs at C5/6. The rate of motion change (RMC) at the fractured level and the internal stress distribution (ISD) were observed. The results showed that longer segments of fixation and combined fixation approaches provided better stability and lowered the maximal stress. The RMC decreased more significantly when the length increased from 1 to 3 levels (302% decrease under flexion, 134% decrease under extension) than from 3 to 5 levels (22% decrease under flexion, 23% decrease under extension). Longer fixation seems to be more stable with the anterior/posterior approach alone, but 3-level posterior fixation may be the most cost-effective option. It is recommended to perform surgery with combined approaches, which provide the best stability. Long skipped-screwing posterior fixation is an alternative technique for use in ASCF patients.

Section: Discussionmentioning

confidence: 99%

Biomechanical influence of the surgical approaches, implant length and density in stabilizing ankylosing spondylitis cervical spine fracture

Wang

et al. 2021

Sci Rep

“…Comparison of ASIA grades at admission, discharge, and the last follow-up. bined anterior-posterior approach was most commonly used in the cervical spine similar to that of other operative series; 18,[22][23][24] each patient's fracture should be individually assessed for the need for circumferential stabilization. 25,26 In this series, the degree of EDH determined the number of laminectomy levels with the goal of complete decompression of underlying neural elements.…”

Section: Discussionmentioning

confidence: 99%

Single versus dual operative spine fractures in ankylosing spondylitis

Blitstein

Talbott

et al. 2021

Neurosurgical Focus

OBJECTIVE Ankylosing spondylitis, the most common spondyloarthritis, fuses individual spinal vertebrae into long segments. The unique biomechanics of the ankylosed spine places patients at unusually high risk for unstable fractures secondary to low-impact mechanisms. These injuries are unique within the spine trauma population and necessitate thoughtful management. Therefore, the authors aimed to present a richly annotated data set of operative AS spine fractures with a significant portion of patients with simultaneous dual noncontiguous fractures. METHODS Patients with ankylosing spondylitis with acute fractures who received operative management between 2012 and 2020 were reviewed. Demographic, admission, surgical, and outcome parameters were retrospectively collected and reviewed. RESULTS In total, 29 patients were identified across 30 different admissions. At admission, the mean age was 71.7 ± 11.8 years. The mechanism of injury in 77% of the admissions was a ground-level fall; 30% also presented with polytrauma. Of admissions, 50% were patient transfers from outside hospitals, whereas the other half presented primarily to our emergency departments. Fifty percent of patients sustained a spinal cord injury, and 35 operative fractures were identified and treated in 32 surgeries. The majority of fractures clustered around the cervicothoracic (C4–T1, 48.6%) and thoracolumbar (T8–L3, 37.11%) junctions. Five patients (17.2%) had simultaneous dual noncontiguous operative fractures; these patients were more likely to have presented with a higher-energy mechanism of injury such as a bicycle or motor vehicle accident compared with patients with a single operative fracture (60% vs 8%, p = 0.024). On preoperative MRI, 56.3% of the fractures had epidural hematomas (EDHs); 25% were compressive of the underlying neural elements, which dictated the number of laminectomy levels performed (no EDH, 2.1 ± 2.36; noncompressive EDH, 2.1 ± 1.85; and compressive EDH, 7.4 ± 4 [p = 0.003]). The mean difference in instrumented levels was 8.7 ± 2.6 with a mean estimated blood loss (EBL) of 1183 ± 1779.5 mL. Patients on a regimen of antiplatelet therapy had a significantly higher EBL (2635.7 mL vs 759.4 mL, p = 0.015). Overall, patients had a mean hospital length of stay of 15.2 ± 18.5 days; 5 patients died during the same admission or after transfer to an outside hospital. Nine of 29 patients (31%) had died by the last follow-up (the mean follow-up was 596.3 ± 878.9 days). CONCLUSIONS Patients with AS who have been found to have unstable spine fractures warrant a thorough diagnostic evaluation to identify secondary fractures as well as compressive EDHs. These patients experienced prolonged inpatient hospitalizations with significant morbidity and mortality.

J. Natl Inst. Neurosci Bangladesh

“…Moreover, the disadvantage of posterior decompression include progressive deformity and instability of the spine and possibly less recovery of neurological function due to less complete and thorough decompression of the spinal cord 13 . These are strongly appreciated by different studies [14][15] and have been stated that anterior cervical plating has numerous potential benefits as an adjunct to anterior cervical discectomy and fusion (ACDF). It provides rigid fixation, resists graft settling, promotes higher fusion rates, allows less cumbersome external immobilization, and reduce the incidence of graft extrusions.…”

Section: 38mentioning

confidence: 99%

Determination of Early Neurological Outcome by ASIA score following Delayed Anterior Decompression and Stabilization of Lower Cervical Spine Injury

Haque

Hossain

Rahman

et al. 2018

Background: Surgical management of lower cervical spine injury is a very important issue among these patients. Objective: The purpose of the present study was todetermine the early neurological outcome of delayed anterior decompression and stabilization of lower cervical spine injury. Methodology: This cross sectional study was carried out in the Department of Neurosurgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh within the period of January 2010 to July 2011 for a period of one year and 6 months. Neurological outcome following anterior decompression and stabilization of lower cervical spine injury was observe. Patients presented with lower cervical spine injury were included in this prospective study. Quantification of neurologic deficit in lower cervical spine injury patients were carried out by following The American Spinal Injury Association (ASIA) impairment scale. Early neurological outcome was also assessed after operation by using ASIA impairment scale in the follow up period at one, three and six months interval. Result: A total of 31 patients were included in this study. Based on the ASIA impairment scale, preoperatively, 6.4 5% of the injuries were grade A, 16.13 % of the injuries were Grade B, 16.13% of the injuries were Grade C and 35.48 % of the injuries were Grade D. early post-operative complications include dysphagia in 3 5.48% cases, donor site infection in 9.67% cases, CSF leak in 3.22%; catheter related urinary tract infection 9.67% and bed sore occurred in 6.45% cases. Conclusion: In conclusion significant neurological recovery can be expected following delayed anterior decompression and stabilization of lower cervical spine in lower cervical spine injury patient. Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 82-86