Kanter Adam S, Wang Michael Y, Mummaneni Praveen V
Department of Neurosurgery, University of California, San Francisco, California 94143, USA.
Neurosurg Focus. 2008;24(1):E11. doi: 10.3171/FOC/2008/24/1/E11.
Patients with ankylosing spondylitis (AS) who present with cervical spine fractures represent a unique challenge to spine surgeons. These injuries often result in neurological deficits that necessitate early and aggressive surgical management with posterior and/or anterior fixation. The authors introduce a clinical problem-solving algorithm to assist in the surgical management of instability and deformity in this exigent patient population.
Thirteen patients with AS and fractures of the cervical spine were radiographically evaluated to determine if spinal realignment was obtainable with cervical manipulation or traction. Seven patients had flexible deformities that were stabilized with either anterior or posterior fixation only, and 6 patients had fixed deformities and required circumferential anterior-posterior instrumentation. All patients were observed for neurological outcome, radiographic evidence of bone fusion, and complications.
With the use of the authors' treatment algorithm, all patients were able to achieve satisfactory spinal realignment and bone fusion; 92% of patients achieved postoperative stability or improvement in Nurick and modified Japanese Orthopaedic Association scale scores. One patient experienced neurological deterioration following surgery, and 1 patient died at an acute rehabilitative facility following discharge.
Patients with AS are highly susceptible to extensive neurological injury and spinal deformity after sustaining cervical fractures from even minor traumatic forces. These injuries are uniquely complex in nature and require considerable scrutiny and aggressive surgical management to optimize spinal stability and functional outcomes. The authors' clinical problem-solving algorithm will assist spine surgeons in providing optimal care in this difficult population.
患有颈椎骨折的强直性脊柱炎（AS）患者给脊柱外科医生带来了独特的挑战。这些损伤常导致神经功能缺损，需要早期积极的手术治疗，采用后路和/或前路固定。作者介绍一种临床问题解决算法，以协助对这一急症患者群体的不稳定和畸形进行手术管理。
对13例患有AS且颈椎骨折的患者进行影像学评估，以确定通过颈椎手法整复或牵引能否实现脊柱复位。7例患者存在柔韧性畸形，仅通过前路或后路固定得以稳定，6例患者存在固定性畸形，需要前后路联合器械固定。观察所有患者的神经功能转归、骨融合的影像学证据及并发症情况。
采用作者的治疗算法，所有患者均能实现满意的脊柱复位和骨融合；92%的患者术后稳定性得以改善，或Nurick评分及改良日本骨科协会（JOA）评分有所提高。1例患者术后出现神经功能恶化，1例患者出院后在急性康复机构死亡。
AS患者即使受到轻微外力导致颈椎骨折后，也极易发生广泛的神经损伤和脊柱畸形。这些损伤本质上极为复杂，需要仔细检查并积极进行手术管理，以优化脊柱稳定性和功能转归。作者的临床问题解决算法将有助于脊柱外科医生为这一困难患者群体提供最佳治疗。
