1Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles.
3University of California, Riverside (UCR) School of Medicine, Riverside, California; and.
Neurosurg Focus. 2021 Oct;51(4):E5. doi: 10.3171/2021.7.FOCUS21334.
Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen-B27. There appears to be an increased frequency of associated epidural hematomas in spine fractures in patients with AS. The objective was to review the incidence within the literature and a single-institution experience of the occurrence of epidural hematoma in the context of patients with AS requiring spine surgery.
Deep 6 AI software was used to search the entire database of patients at a single level I trauma center (since the advent of the institution's modern electronic health record system) to look at all patients with AS who underwent spinal surgery and who had a diagnosis of epidural hematoma. Additionally, a systemic literature review was performed of all papers evaluating the incidence of epidural hematoma in patients with spine fractures.
A single-institution, retrospective review of records from 2009 to 2020 yielded a total of 164 patients with AS who underwent spine surgery. Of those patients, 17 (10.4%) had epidural hematomas on imaging, with the majority requiring surgical decompression. These spine fractures occurred close to the cervicothoracic or thoracolumbar junction. The patients ranged in age from 51 to 88 years, and there were 14 males and 3 females in the cohort. Eight patients were administered an antiplatelet and/or anticoagulant agent, and the rest were not. All patients required surgical stabilization, with 64.7% of patients also requiring decompressive laminectomies for evacuation of the hematoma and spinal cord decompression. Only 1 death was reported in the series. There was a tendency toward neurological improvement after surgical intervention.
AS has been a well-described pathologic process that leads to an increased risk of three-column injury in spine fracture, with an increased incidence of symptomatic epidural hematoma compared with patients without AS. Early recognition of this entity is important to ensure that appropriate surgical management includes addressing compression of the neural elements in addition to surgical stabilization.
强直性脊柱炎（AS）是一种慢性炎症性疾病，影响骶髂关节和脊柱轴向，与人类白细胞抗原-B27 密切相关。在 AS 患者的脊柱骨折中，似乎硬膜外血肿的发生率增加。目的是回顾文献中的发病率和单一机构的经验，即在需要脊柱手术的 AS 患者中发生硬膜外血肿的情况。
使用 Deep 6 AI 软件搜索单一一级创伤中心（自该机构现代电子健康记录系统问世以来）的整个患者数据库，以查看所有接受脊柱手术且有硬膜外血肿诊断的 AS 患者。此外，还对所有评估脊柱骨折患者硬膜外血肿发生率的论文进行了系统的文献回顾。
对 2009 年至 2020 年的记录进行了单机构回顾性研究，共纳入 164 例接受脊柱手术的 AS 患者。在这些患者中，17 例（10.4%）在影像学上有硬膜外血肿，其中大多数需要手术减压。这些脊柱骨折发生在颈椎或胸腰椎交界处附近。患者年龄在 51 岁至 88 岁之间，队列中有 14 名男性和 3 名女性。8 名患者接受了抗血小板和/或抗凝药物治疗，其余患者未接受治疗。所有患者均需要手术稳定，其中 64.7%的患者还需要减压性椎板切除术以清除血肿和脊髓减压。该系列报告仅 1 例死亡。手术干预后有神经功能改善的趋势。
AS 是一种已被充分描述的病理过程，导致脊柱骨折中三柱损伤的风险增加，与没有 AS 的患者相比，症状性硬膜外血肿的发生率增加。早期识别该实体很重要，以确保适当的手术管理包括解决神经结构的压迫，除了手术稳定之外。
