HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland.
Department of Neurosurgery, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland.
Emerg Radiol. 2021 Jun;28(3):601-611. doi: 10.1007/s10140-020-01881-3. Epub 2021 Jan 16.
The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) in post-traumatic ankylosing spondylitis (AS) patients.
A total of 2256 consecutive referrals for urgent and emergency MRI scans of the spine over a period of eight years and nine months were manually reviewed for any mentions indicating axial ankylosis and post-traumatic spinal hematoma. We found 164 patients with ankylosed spines complicated by spinal fracture, of whom 32 had AS. Of the 132 excluded patients, 80 had diffuse idiopathic skeletal hyperostosis (DISH). The primary outcome was the presence of spinal hematoma, and the secondary outcome was spinal canal narrowing and spinal cord impingement. Two musculoskeletal radiologists and one fellow in musculoskeletal radiology reviewed the images for the presence of spinal hematoma and related signal characteristics, blinded to one another and initial reports.
Of 28 post-traumatic AS patients, 19 had SEHs and five had spinal SSHs. There was a statistically significant difference between Frankel grades before and after surgery in respect of neurological improvement (p = 0.008). Patients who had radiologically proven spinal cord impingement showed more severe neurological deficits (p = 0.012). Hematomas with T1 heterogeneity showed a significantly increased delay (p = 0.047) between injury and imaging, while other signal characteristics were only approximate.
Both SEH and SSH are common complications in post-traumatic AS patients. Patients benefit from surgery, but the relevance of spinal hematoma as a separate factor causing neurological deficit remains unclear.
本研究旨在探讨创伤后强直性脊柱炎（AS）患者的脊柱硬膜外血肿（SEH）和脊柱硬脊膜下血肿（SSH）的发生率、部位和磁共振成像（MRI）特征。
对八年内九个月内 2256 例紧急和急诊脊柱 MRI 检查的连续转诊患者进行了手动审查，以查找任何表明轴向强直和创伤后脊柱血肿的记录。我们发现 164 例强直性脊柱炎脊柱骨折患者，其中 32 例为 AS。在 132 例排除的患者中，80 例患有弥漫性特发性骨肥厚（DISH）。主要结果是存在脊柱血肿，次要结果是椎管狭窄和脊髓压迫。两位肌肉骨骼放射科医生和一位肌肉骨骼放射科研究员对图像进行了评估，以评估脊柱血肿及其相关信号特征，彼此和初始报告均为盲法。
在 28 例创伤后 AS 患者中，19 例存在 SEH，5 例存在脊髓 SSH。在手术前后的 Frankel 分级方面，神经功能改善存在统计学差异（p=0.008）。影像学证实有脊髓压迫的患者表现出更严重的神经功能缺损（p=0.012）。具有 T1 异质性的血肿在损伤和成像之间显示出明显的延迟（p=0.047），而其他信号特征仅为近似值。
SEH 和 SSH 都是创伤后 AS 患者的常见并发症。患者受益于手术，但脊柱血肿作为引起神经功能缺损的单独因素的相关性尚不清楚。
