Surgical Outcomes of Minimally Invasive Stabilization for Spinal Fractures in Patients with Ankylosing Spinal Disorders

Abstract

Study DesignA retrospective study.PurposeTo evaluate the clinical and radiological outcomes of ankylosing spinal disorder (ASD) patients with spinal fractures treated by minimally invasive stabilization (MISt) using percutaneous pedicle screws (PPSs).Overview of LiteratureASDs, such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), increase susceptibility to spinal fractures because of extremely decreased spinal flexibility. Such fractures tend to be unstable and, consequently, should be treated with multiple-segmental internal fixation. However, conventional internal fixation procedures can severely damage the soft tissue, resulting in severe hemorrhage. Therefore, MISt is the preferred approach to treat spinal fractures in ASD patients.MethodsNine ASD patients (four males and five females; three AS and six DISH patients) with spinal fractures who were treated by MISt using PPSs, were reviewed from April 2009 to August 2016. One patient died of aspiration pneumonia during follow-up (FU), and the remaining eight patients underwent clinical and radiological evaluation.ResultsThe mean age at surgery was 79.6 years (range, 68–95 years). The mean duration of postoperative FU was 14.2 months (range, 3–30 months). All treated fractures were anterior and posterior element injuries with distraction. Three patients presented delayed onset preoperative neurological deficit following trauma. The mean operation time was 179.6 minutes (range, 92–340 minutes). The mean hemorrhage was 103.6 mL (range, unquantifiable to 480 mL). Radiological evaluations at FU showed preservation of the acceptable postoperative correction of the fractured vertebra, as there were no re-collapses of the fractured vertebrae during FU.ConclusionsASD patients must be acknowledged as highly susceptible to unstable spinal fractures, even after relatively mild trauma. MISt using PPSs may be an effective treatment for spinal fractures in such patients.

Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases

“…In these two cases, revision surgery was performed. This was even lower than that described by Lindtner et al [14]. They included nine patients in their study and a CST of 180 min for MIS (range: 92-340 min).…”

“…Kai et al found a blood loss of 104 mL (range: unquantifiable to 480 mL) but did not describe the technique for calculating blood loss in detail [ 14 ]. In our study, we followed the calculation of blood loss by Gombotz et al [ 21 ].…”

“…CST was not significantly influenced by the AOSpine distribution. Kai et al reported posterior fixation through MIS in patients with ASD in 2018 [ 14 ]. They included nine patients in their study and a CST of 180 min for MIS (range: 92–340 min).…”

“…These differences contrast with known biological advantages for MIS in perioperative outcome, such as significantly reduce soft tissue damage. Compared with OS, a significantly lower blood loss and lower postoperative complication rate can be expected [ 14 , 15 ].…”

Relationship between dementia and ankylosing spondylitis: A nationwide, population-based, retrospective longitudinal cohort study

“…The condition leads to frequent back pain and stiffness of the affected joints. [1–3] Because there is no cure for the disease itself and because onset typically happens early in young adults who are socially active, AS patients obviously suffer from decreased quality of life (QOL) with long-lasting emotional and functional impairments. [4–12] These disease characteristics also affect the disease comorbidities: risks of major degenerative diseases—including cardiovascular or cerebrovascular problems—and mental disorders in AS are significantly higher than in the general population, as reported in several published papers.…”