Teunissen Frederik R, Verbeek Bianca M, Cha Thomas D, Schwab Joseph H
J Neurosurg Spine. 2017 Dec;27(6):709-716. doi: 10.3171/2017.5.SPINE1722. Epub 2017 Oct 6.
OBJECTIVE Spinal cord injury (SCI) is a major complication of spinal fractures in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). Due to the uncommon nature of these conditions, existing literature consists of relatively small case series without detailed neurological data. This study aims to investigate the incidence, predictors, and sequelae of SCI in patients with a traumatic fracture of the ankylosed spine. METHODS The study included all patients older than 18 years of age with AS or DISH who presented to two affiliated tertiary care centers between January 1, 1990, and January 1, 2016, and had a traumatic fracture of the spine. Factors associated with SCI after traumatic fracture were compared using Fisher's exact tests. Logistic regression was used for the analysis of predictive factors for SCI. For the comparison of probability of survival between patients with and without SCI, Kaplan-Meier methodology was used. RESULTS One hundred seventy-two patients with a traumatic fracture of an ankylosed spine were included. Fifty-seven patients (34.1%) had an SCI associated with the fracture. The cervical spine was the most fractured region for patients both with (77.2%) and without (51.4%) SCI. A cervical fracture (odds ratio [OR] 2.70, p = 0.024) and a spinal epidural hematoma (SEH) after fracture (OR 2.69, p = 0.013) were predictive of SCI. Eleven patients (19.3%) with SCI had delayed SCI (range 8-230 days). Of 44 patients with SCI and sufficient follow-up, 20 (45.5%) had neurological improvement after treatment. Early and late complication rates were significantly higher (p = 0.001 and p = 0.004) and hospital stay was significantly longer (p = 0.001) in patients with SCI. The probability of survival was significantly lower in the SCI group compared with the non-SCI group (p = 0.006). CONCLUSIONS The incidence of SCI was high after fracture of the spine in patients with AS and DISH. Predictive factors for SCI after fracture were a fracture in the cervical spine and an SEH following fracture. One-fifth of the patients with SCI had delayed SCI. Patients with SCI had more complications, a longer hospital stay, and a lower probability of survival. Less than half of the patients with SCI showed neurological improvement.
目的 脊髓损伤（SCI）是强直性脊柱炎（AS）和弥漫性特发性骨肥厚（DISH）患者脊柱骨折的主要并发症。由于这些病症并不常见，现有文献多为相对较小的病例系列，缺乏详细的神经学数据。本研究旨在调查强直性脊柱炎患者脊柱创伤性骨折后脊髓损伤的发生率、预测因素及后遗症。方法 本研究纳入了1990年1月1日至2016年1月1日期间在两家三级医疗中心就诊的所有年龄大于18岁的AS或DISH患者，这些患者均有脊柱创伤性骨折。采用Fisher精确检验比较创伤性骨折后与脊髓损伤相关的因素。使用逻辑回归分析脊髓损伤的预测因素。采用Kaplan-Meier方法比较脊髓损伤患者和非脊髓损伤患者的生存概率。结果 纳入172例强直性脊柱炎患者脊柱创伤性骨折患者。57例（34.1%）患者骨折合并脊髓损伤。颈椎是脊髓损伤患者（77.2%）和非脊髓损伤患者（51.4%）中骨折最多的部位。颈椎骨折（比值比[OR]2.70，p = 0.024）和骨折后脊髓硬膜外血肿（SEH）（OR 2.69，p = 0.013）是脊髓损伤的预测因素。11例（19.3%）脊髓损伤患者出现延迟性脊髓损伤（8 - 230天）。在44例有充分随访的脊髓损伤患者中，20例（45.5%）治疗后神经功能有改善。脊髓损伤患者的早期和晚期并发症发生率显著更高（p = 0.001和p = 0.004），住院时间显著更长（p = 0.001）。与非脊髓损伤组相比，脊髓损伤组的生存概率显著更低（p = 0.006）。结论 AS和DISH患者脊柱骨折后脊髓损伤的发生率较高。骨折后脊髓损伤的预测因素是颈椎骨折和骨折后脊髓硬膜外血肿。五分之一的脊髓损伤患者出现延迟性脊髓损伤。脊髓损伤患者并发症更多，住院时间更长，生存概率更低。不到一半的脊髓损伤患者神经功能有改善。
