Martin Vazan1, Yu-Mi Ryang2, Melanie Barz2, Elisabeth Török2, Jens Gempt2, Bernhard Meyer2. 1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany; Department of Orthopaedics, Municipal Hospital Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany. Electronic address: martin.vazan@gmail.com. 2. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Abstract
BACKGROUND: In patients with ankylosing spinal disease, including ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, even low-impact trauma can lead to complex injuries. The injuries seem to be highly unstable and associated with greater mortality rates compared with the general spine trauma population. METHODS: We reviewed the medical records of a consecutive series of 41 patients (34 men, 7 women) with ankylosing spinal disease and unstable traumatic spine injuries who were admitted to our department from 2007 to 2016. RESULTS: The mean patient age was 73.4 ± 12.7 years. Of the 41 patients, 24 (58.5%) had ankylosing spondylitis and 17 (41.5%) had diffuse idiopathic skeletal hyperostosis. Low-velocity accidents were documented in 38 patients (92.7%). The most frequent injuries were type B spine fractures (61.0%). Accompanying spinal epidural hematoma was detected using magnetic resonance imaging in 12 patients (29.3%) but was not found by radiography or computed tomography. Of the 41 patients, 24 (58.5%) presented with American Spinal Injury Association impairment scale (AIS) grade E, 6 (14.6%) with grade D, and 8 (19.6%) with grade C or worse. All the patients had undergone internal fixation. All but 1 (97.6%) had received posterior fixation. In 25 (61%), a combined approach was performed. Five patients died of early complications. Of the 36 discharged patients, 11 died during the follow-up period and 1 was lost to follow-up. The surviving 24 patients had a median follow-up of 733 ± 576 days; 21 had AIS grade E, 2 had AIS grade D, and 1 had AIS grade C. CONCLUSIONS: A thorough diagnostic evaluation with multislice computed tomography and magnetic resonance imaging can reveal injuries that would remain undetected on conventional radiographs. A combined approach or posterior-only fixation seems safe.
BACKGROUND: In patients with ankylosing spinal disease, including ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, even low-impact trauma can lead to complex injuries. The injuries seem to be highly unstable and associated with greater mortality rates compared with the general spine trauma population. METHODS: We reviewed the medical records of a consecutive series of 41 patients (34 men, 7 women) with ankylosing spinal disease and unstable traumatic spine injuries who were admitted to our department from 2007 to 2016. RESULTS: The mean patient age was 73.4 ± 12.7 years. Of the 41 patients, 24 (58.5%) had ankylosing spondylitis and 17 (41.5%) had diffuse idiopathic skeletal hyperostosis. Low-velocity accidents were documented in 38 patients (92.7%). The most frequent injuries were type B spine fractures (61.0%). Accompanying spinal epidural hematoma was detected using magnetic resonance imaging in 12 patients (29.3%) but was not found by radiography or computed tomography. Of the 41 patients, 24 (58.5%) presented with American Spinal Injury Association impairment scale (AIS) grade E, 6 (14.6%) with grade D, and 8 (19.6%) with grade C or worse. All the patients had undergone internal fixation. All but 1 (97.6%) had received posterior fixation. In 25 (61%), a combined approach was performed. Five patients died of early complications. Of the 36 discharged patients, 11 died during the follow-up period and 1 was lost to follow-up. The surviving 24 patients had a median follow-up of 733 ± 576 days; 21 had AIS grade E, 2 had AIS grade D, and 1 had AIS grade C. CONCLUSIONS: A thorough diagnostic evaluation with multislice computed tomography and magnetic resonance imaging can reveal injuries that would remain undetected on conventional radiographs. A combined approach or posterior-only fixation seems safe.
Authors: David N Bernstein; Daren J McCalla; Robert W Molinari; Paul T Rubery; Emmanuel N Menga; Addisu Mesfin Journal: Global Spine J Date: 2019-11-12
Authors: Christopher Ull; Emre Yilmaz; Martin F Hoffmann; Charlotte Reinke; Mirko Aach; Thomas Armin Schildhauer; Christiane Kruppa Journal: Global Spine J Date: 2021-01-12