Department of Orthopaedics, KAT General Hospital, Kifissia, Greece.
BMC Musculoskelet Disord. 2009 Aug 2;10:96. doi: 10.1186/1471-2474-10-96.
Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine.The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned.
Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge.
Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed.
The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.
强直性脊柱炎是一种主要影响脊柱和骶髂关节的风湿性疾病。脊柱韧带逐渐骨化，脊柱关节融合，导致脊柱僵硬。晚期强直性脊柱炎弥漫性脊柱旁骨化和炎症性骨炎导致融合、脆弱的脊柱容易骨折。本研究旨在介绍强直性脊柱炎患者脊柱骨折的手术经验，并强调在诊断和手术管理方面存在的困难。
20 例强直性脊柱炎患者因脊柱骨折接受手术。骨折位于颈椎 7 例，胸椎 9 例，胸腰椎交界处 3 例，腰椎 1 例。10 例患者出现神经缺损。其中 4 例在 4 至 15 天的时间后出现进行性神经体征。12 例患者的初始影像学研究未发现脊柱骨折。每位患者在入院时和每天直至手术日进行评估，然后在出院时进行评估。
3 例患者采用前路和后路联合入路，其余患者仅采用后路入路。所有病例均行脊柱融合。术中无并发症。1 例患者出现浅表伤口炎症。2 例颈椎损伤患者出现后路螺钉松动但无稳定性丧失。使用 Frankel 神经功能分类法评估患者的神经状态。术前和术后评估之间的 Frankel 神经功能分类有统计学显著改善。由于手术，35%的患者神经状态得到改善。
这些损伤的手术治疗是有用和有效的。它通常可以改善患者的神经状态。考虑到这些患者存在心血管问题，并非总是可以进行前后稳定。在这些情况下，可以进行后路入路，可获得良好的效果，同时减少总手术时间、出血量和其他可能的并发症。
