Surgical Approach to Cervical Fractures in Ankylosing Spondylitis Patients: Rationale and Surgical Strategy

Shetty, Ajoy Prasad; Murugan, Chandhan; S, Sri Vijay Anand K; Yarlagadda, Akhileswari; Naik, Ashish Shankar; Kanna, Rishi Mugesh; Rajasekaran, S.

doi:10.1016/j.wneu.2023.02.046

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…[32][33][34][35] However, the risks of local kyphosis aggravated by conservative treatment, nonunion caused by shear forces, neurological deterioration, bedsores and respiratory complications caused by prolonged bed rest, and skin damage caused by long-term brace wear have increasingly aroused the attention of clinicians. 28 At the same time, with the continuous improvement of surgical techniques, internal fixation provides better reduction and maintains stability during bone healing, and also has advantages in relieving spinal cord compression and reducing the time of bed immobilization, Gradually, conservative treatment has been gradually replaced by surgical treatment. 30 Current literature regarding ankylosing spondylitis combined with cervical spine fracture management has established that surgical treatment is superior to conservative management in terms of efficacy and life expectancy, but the ideal approach for surgical treatment remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…12,26,27 In Shetty's study, four patients presented to the hospital with neurological symptoms several days after a trauma despite having intact neurological function immediately after trauma. 28 Simultaneously, changes in spinal anatomy, ligament ossification, and artifacts resulting from the development of long-term AS conditions may cause X-ray imaging of the cervical spine to fail to identify fractures in a timely manner. 29 In Kouyoumdjian and Sapkas' study, 36% and 60% of patients failed to accurately diagnose cervical spine fracture in the initial radiographic findings, resulting in delayed diagnosis and increased risk of neurological complications.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

Peng,

Luan,

Liu

et al. 2024

Global Spine Journal

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Study Design Systematic review. Objective To compare the efficacy of the posterior approach and combined anterior-posterior approach in the treatment of ankylosing spondylitis (AS) with cervical spine fracture by meta-analysis. Methods The databases PubMed, Web of Science, Embase, and Cochrane Library were searched for studies on the comparison of the posterior approach group and the combined anterior-posterior approach group in the treatment of ankylosing spondylitis combined with cervical spine fracture from database establishment to August 2023. The procedure time, intraoperative blood loss, the rates of neurological improvement, mean change in the postoperative neurological function, complication rates, rates of revised surgery, and mortality were extracted. Meta-analysis was performed using RevMan 5.4 software provided by Cochrane Library. Results A total of 11 retrospective cohort studies with a total of 215 patients were included in this study. The posterior approach group had lower intraoperative blood loss than the combined anterior-posterior approach group [Mean difference (MD) = -146.05, 95%CI(-187.40,-104.69), P < .00001]; the operation time was significantly less in the posterior approach group than in the combined anterior-posterior approach group [MD = -95.34, 95%CI(-113.13,-77.55), P < .00001]. There were no statistically significant differences in the neurological improvement rates, mean changes in postoperative neurological function, complication rates, modified surgery rates, and mortality rates. Conclusion Both the posterior approach and combined anterior and posterior approach can achieve good results. Clinicians should develop an individualized approach based on the patient's fracture type, degree of spinal cord injury, fracture stability, fracture dislocation, general condition, and underlying disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

Peng,

Luan,

Liu

et al. 2024

Global Spine Journal

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“…The patient underwent a revision surgery using a posterior approach, which enabled complete decompression, reduction, and internal fixation through laminectomy and pedicle screws. In cases of cervical spine injuries in patients with ankylosing spondylitis, the combined anterior and posterior approach is the most preferred method for surgical treatment [17][18][19]. Liu et al typically employ a comprehensive approach to revise and restore the firm stability of the cervical spine [20].…”

Section: Discussionmentioning

confidence: 99%

Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report

Wu,

Xiao,

Lin

et al. 2024

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Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that affects the sacroiliac joints and surrounding joints. It is a seronegative spondyloarthritis that invades connective tissue. Managing cervical spine fractures in patients with AS is particularly challenging due to the severity of the deformity and the instability of the fracture. Cervical spine fracture combined with spinal cord injury is the leading cause of death and is strongly correlated with in-hospital mortality in patients with ankylosing spondylitis. There have been limited reports on the revision of cervical spine fractures after internal fixation in patients with AS. The case report is about a patient who is a 34-year-old man who underwent emergency surgery at a local hospital for a cervical spine fracture resulting from a car accident. A postoperative review revealed that the anterior internal fixation was detached, leading to a revision surgery being performed according to the patient's actual condition. Unfortunately, the internal fixation became dislodged fol-lowing the initial surgery, exacerbating the patient's condi-tion and leading to the development of pneumonia. In order to prevent the need for revision surgery, it is crucial to carefully evaluate and determine the most suitable surgical approach for patients with cervical spine fractures and spinal cord injury before proceeding with the initial surgery.

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“…The higher potential for instability in these patients is ascribed to longer levers around the injured segment. This is acknowledged in clinical studies and guidelines, where long posterior or combined stabilization constructs are recommended [2,3,17].…”

Section: Risk Factors and Patient Characteristicsmentioning

confidence: 99%

Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment

Raisch,

Pflästerer,

Kreinest

et al. 2024

JCM

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Introduction: This study analyzed the incidence of secondary dislocations (sDLs) after surgical stabilization of AO Spine type B and C injuries of the subaxial cervical spine (sCS). Materials and Methods: Patients treated for injuries of the sCS from 2010 to 2020 were retrospectively analyzed for the incidence of sDL within 60 days after first surgery. A univariate analysis of variables potentially influencing the risk of sDL was performed. Patients with solitary anterior stabilization underwent subgroup analysis. The treatment of sDLs was described. Results: A total of 275 patients were included. sDLs occurred in 4.0% of patients (n = 11) in the total sample, most frequently after solitary anterior stabilization with 8.0% (n = 10, p = 0.010). Only one sDL occurred after combined stabilization and no sDLs after posterior stabilization. In the total sample and the anterior subgroup, variables significantly associated with sDL were older age (p = 0.001) and concomitant unstable facet joint injury (p = 0.020). No neurological deterioration occurred due to sDL and most patients were treated with added posterior stabilization. sDL is frequent after solitary anterior stabilization and rare after posterior or combined stabilization. Discussion: Patients of higher age and with unstable facet joint injuries should be followed up diligently to detect sDLs in time. Neurological deterioration does not regularly occur due to sDL, and most patients can be treated with added posterior stabilization.

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Surgical Approach to Cervical Fractures in Ankylosing Spondylitis Patients: Rationale and Surgical Strategy

Cited by 4 publications

References 21 publications

Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report

Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment

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