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Spinal fractures in patients with ankylosing spondylitis

Rheumatology International volume 36, pages 1335–1346 (2016)Cite this article

Abstract

The ankylosed spine is prone to fracture even after minor trauma due to its changed biomechanical properties. The two central features of ankylosing spondylitis (AS) that promote the pathological remodeling of the spine are inflammation and new bone formation. AS is also associated with osteoporosis that is attributed to an uncoupling of the bone formation and bone resorption processes. Therefore, bone resorption occurs and promotes weakening of the spine as well as increased risk of vertebral fractures which can be hugely different in terms of clinical relevance. Even in the presence of symptomatic clinical vertebral fractures, the diagnosis can be overruled by attributing the pain to disease activity. Furthermore, given the highly abnormal structure of the spine, vertebral fracture diagnosis can be difficult on the basis of radiography alone. CT can show the fractures in detail. Magnetic resonance imaging is considered the method of choice for the imaging of spinal cord injuries, and a reasonable option for exclusion of occult fractures undetected by CT. Since it is equally important for radiologists and clinicians to have a common knowledge base rather than a compartmentalized view, the aim of this review article was to provide the required clinical knowledge that radiologists need to know and the relevant radiological semiotics that clinicians require in diagnosing clinically significant injury to the ankylosed spine.

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References

  1. Jacobs WB, Fehlings MG (2008) Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance. Neurosurg Focus 24(1):E12

    Article  PubMed  Google Scholar 

  2. Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145–156

    Article  CAS  PubMed  Google Scholar 

  3. Finkelstein JA, Chapman JR, Mirza S (1999) Occult vertebral fractures in ankylosing spondylitis. Spinal Cord 37(6):444–447

    Article  CAS  PubMed  Google Scholar 

  4. Masiero S, Bonaldo L, Pigatto M, Lo Nigro A, Ramonda R, Punzi L (2011) Rehabilitation treatment in patients with ankylosing spondylitis stabilized with tumor necrosis factor inhibitor therapy: a randomized controlled trial. J Rheumatol 38(7):1335–1342

    Article  CAS  PubMed  Google Scholar 

  5. Waldman SK, Brown C, Lopez de Heredia L, Hughes RJ (2013) Diagnosing and managing spinal injury in patients with ankylosing spondylitis. J Emerg Med 44(4):e315–e319

    Article  PubMed  Google Scholar 

  6. Geusens P, Vosse D, van der Linden S (2007) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19(4):335–339

    Article  PubMed  Google Scholar 

  7. Sambrook PN, Geusens P (2012) The epidemiology of osteoporosis and fractures in ankylosing spondylitis. Ther Adv Musculoskelet Dis 4(4):287–292

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vosse D, Feldtkeller E, Erlendsson J, Geusens P, van der Linden S (2004) Clinical vertebral fractures in patients with ankylosing spondylitis. J Rheumatol 31(10):1981–1985

    PubMed  Google Scholar 

  9. Smith JA (2015) Update on ankylosing spondylitis: current concepts in pathogenesis. Curr Allergy Asthma Rep 15(1):489

    Article  PubMed  Google Scholar 

  10. Ghozlani I, Ghazi M, Nouijai A et al (2009) Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 44(5):772–776

    Article  CAS  PubMed  Google Scholar 

  11. Leone A, Cassar-Pullicino VN, Casale R, Magarelli N, Semprini A, Colosimo C (2015) The SAPHO syndrome revisited with an emphasis on spinal manifestations. Skelet Radiol 44(1):9–24

    Article  Google Scholar 

  12. Paparo F, Revelli M, Semprini A et al (2014) Seronegative spondyloarthropathies: what radiologists should know. Radiol Med 119(3):156–163

    Article  PubMed  Google Scholar 

  13. Goldring SR (2015) Inflammatory signaling induced bone loss. Bone 80:143–149

    Article  CAS  PubMed  Google Scholar 

  14. Lories RJ, Luyten FP, de Vlam K (2009) Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis. Arthritis Res Ther 11(2):221

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lories RJ, Derese I, Ceuppens JL, Luyten FP (2003) Bone morphogenetic proteins 2 and 6, expressed in arthritic synovium, are regulated by proinflammatory cytokines and differentially modulate fibroblast-like synoviocyte apoptosis. Arthritis Rheum 48(10):2807–2818

    Article  CAS  PubMed  Google Scholar 

  16. Lories RJ, Derese I, Luyten FP (2005) Modulation of bone morphogenetic protein signaling inhibits the onset and progression of ankylosing enthesitis. J Clin Invest 115(6):1571–1579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lories RJ, Schett G (2012) Pathophysiology of new bone formation and ankylosis in spondyloarthritis. Rheum Dis Clin N Am 38(3):555–567

    Article  Google Scholar 

  18. Davey-Ranasinghe N, Deodhar A (2013) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 25(4):509–516

    Article  PubMed  Google Scholar 

  19. Taylan A, Sari I, Akinci B et al (2012) Biomarkers and cytokines of bone turnover: extensive evaluation in a cohort of patients with ankylosing spondylitis. BMC Musculoskelet Disord 13:191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Appel H, Ruiz-Heiland G, Listing J et al (2009) Altered skeletal expression of sclerostin and its link to radiographic progression in ankylosing spondylitis. Arthritis Rheum 60(11):3257–3262

    Article  PubMed  Google Scholar 

  21. Daoussis D, Andonopoulos AP (2011) The emerging role of Dickkopf-1 in bone biology: is it the main switch controlling bone and joint remodeling? Semin Arthritis Rheum 41(2):170–177

    Article  CAS  PubMed  Google Scholar 

  22. Uderhardt S, Diarra D, Katzenbeisser J et al (2010) Blockade of Dickkopf (DKK)-1 induces fusion of sacroiliac joints. Ann Rheum Dis 69(3):592–597

    Article  CAS  PubMed  Google Scholar 

  23. Magrey M, Khan MA (2010) Osteoporosis in ankylosing spondylitis. Curr Rheumatol Rep 12(5):332–336

    Article  PubMed  Google Scholar 

  24. Montala N, Juanola X, Collantes E et al (2011) Prevalence of vertebral fractures by semiautomated morphometry in patients with ankylosing spondylitis. J Rheumatol 38(5):893–897

    Article  PubMed  Google Scholar 

  25. Feldtkeller E, Vosse D, Geusens P, van der Linden S (2006) Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis. Rheumatol Int 26(3):234–239

    Article  PubMed  Google Scholar 

  26. Bessant R, Keat A (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29(7):1511–1519

    PubMed  Google Scholar 

  27. Gran JT, Husby G (1998) Clinical, epidemiologic, and therapeutic aspects of ankylosing spondylitis. Curr Opin Rheumatol 10(4):292–298

    Article  CAS  PubMed  Google Scholar 

  28. Klingberg E, Gejer M, Göthlin J et al (2012) Vertebral fractures in ankylosing spondylitis are associated with lower bone mineral density in both central and peripheral skeleton. J Rheumatol 39(10):1987–1995

    Article  PubMed  Google Scholar 

  29. Geusens P, De Winter L, Quaden D et al (2015) The prevalence of vertebral fractures in spondyloarthritis: relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma. Arthritis Res Ther 17:294

    Article  PubMed  PubMed Central  Google Scholar 

  30. Will R, Palmer R, Bhalla AK, Ring F, Calin A (1989) Osteoporosis in early ankylosing spondylitis: a primary pathologic event? Lancet 2(8678–8679):1483–1485

    Article  CAS  PubMed  Google Scholar 

  31. Cooper C, Carbone L, Michet CJ, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21(10):1877–1882

    CAS  PubMed  Google Scholar 

  32. Sarikaya S, Basaran A, Tekin Y, Ozdolap S, Ortancil O (2007) Is osteoporosis generalized or localized to central skeleton in ankylosing spondylitis? J Clin Rheumatol 13(1):20–24

    Article  PubMed  Google Scholar 

  33. Klingberg E, Lorentzon M, Göthlin J et al (2013) Bone microarchitecture in ankylosing spondylitis and the association with bone mineral density, fractures and syndesmophytes. Arthritis Res Ther 15(6):R179

    Article  PubMed  PubMed Central  Google Scholar 

  34. Maillefert JF, Aho LS, El Maghraoui A, Dougados M, Roux C (2001) Changes in bone density in patients with ankylosing spondylitis: a two-year follow-up study. Osteoporos Int 12(7):605–609

    Article  CAS  PubMed  Google Scholar 

  35. Franck H, Meurer T, Hofbauer LC (2004) Evaluation of bone mineral density, hormones, biochemical markers of bone metabolism, and osteoprotegerin serum levels in patients with ankylosing spondylitis. J Rheumatol 31(11):2236–2241

    CAS  PubMed  Google Scholar 

  36. Wendling D (2005) Bone loss in ankylosing spondylitis: can we put the puzzle together? J Rheumatol 32(7):1184–1185

    PubMed  Google Scholar 

  37. Walsh NC, Gravallese EM (2004) Bone loss in inflammatory arthritis: mechanisms and treatment strategies. Curr Opin Rheumatol 16(4):419–427

    Article  PubMed  Google Scholar 

  38. Amarasekara DS, Yu J, Rho J (2015) Bone loss triggered by cytokine network in inflammatory autoimmune diseases. J Immunol Res. doi:10.1155/2015/832127

    PubMed  PubMed Central  Google Scholar 

  39. Chavassieux P, Seeman E, Delmas PD (2007) Insights into material and structural basis of bone fragility from diseases associated with fractures: how determinants of the biomechanical properties of bone are compromised by disease. Endocr Rev 28(2):151–164

    Article  CAS  PubMed  Google Scholar 

  40. Thumbikat P, Hariharan RP, Ravichandran G, McClelland MR, Mathew KM (2007) Spinal cord injury in patients with ankylosing spondylitis: a 10-year review. Spine (Phila Pa 1976) 32(26):2989–2995

    Article  Google Scholar 

  41. Einsiedel T, Schmelz A, Arand M et al (2006) Injuries of the cervical spine in patients with ankylosing spondylitis: experience at two trauma centers. J Neurosurg Spine 5(1):33–45

    Article  PubMed  Google Scholar 

  42. Cha TD, An HS (2013) Cervical spine manifestations in patients with inflammatory arthritides. Nat Rev Rheumatol 9(7):423–432

    Article  PubMed  Google Scholar 

  43. Wang YF, Teng MM, Chang CY, Wu HT, Wang ST (2005) Imaging manifestations of spinal fractures in ankylosing spondylitis. AJNR 26(8):2067–2076

    PubMed  Google Scholar 

  44. Fox MW, Onofrio BM, Kilgore JE (1993) Neurological complications of ankylosing spondylitis. J Neurosurg 78(6):871–878

    Article  CAS  PubMed  Google Scholar 

  45. Graham B, Van Peteghem PK (1989) Fractures of the spine in ankylosing spondylitis Diagnosis, treatment, and complications. Spine (Phila Pa 1976) 14(8):803–807

    Article  CAS  Google Scholar 

  46. Alaranta H, Luoto S, Konttinen YT (2002) Traumatic spinal cord injury as a complication to ankylosing spondylitis. An extended report. Clin Exp Rheumatol 20(1):66–68

    CAS  PubMed  Google Scholar 

  47. Olerud C, Frost A, Bring J (1996) Spinal fractures in patients with ankylosing spondylitis. Eur Spine J 5(1):51–55

    Article  CAS  PubMed  Google Scholar 

  48. Hunter T, Forster B, Dvorak M (1995) Ankylosed spines are prone to fracture. Can Fam Phys 41:1213–1216

    CAS  Google Scholar 

  49. Paley D, Schwartz M, Cooper P, Harris WR, Levine AM (1991) Fractures of the spine in diffuse idiopathic skeletal hyperostosis. Clin Orthop Relat Res 267:22–32

    PubMed  Google Scholar 

  50. Fatemi G, Gensler LS, Learch TJ, Weisman MH (2014) Spine fractures in ankylosing spondylitis: a case report and review of imaging as well as predisposing factors to falls and fractures. Semin Arthritis Rheum 44(1):20–24

    Article  PubMed  PubMed Central  Google Scholar 

  51. Pompeu JE, Romano RS, Pompeu SM, Lima SM (2012) Static and dynamic balance in subjects with ankylosing spondylitis: literature review. Rev Bras Reumatol 52(3):409–416

    Article  PubMed  Google Scholar 

  52. Debarge R, Demey G, Roussouly P (2011) Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J 20(5):619–625

    Article  PubMed  PubMed Central  Google Scholar 

  53. Schafer RC (1987) Clinical biomechanics: musculoskeletal actions and reactions. Williams & Wilkins, Baltimore

    Google Scholar 

  54. Bot SD, Caspers M, Van Royen BJ, Toussaint HM, Kingma I (1999) Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology (Oxford) 38(5):441–443

    Article  CAS  Google Scholar 

  55. Murray HC, Elliott C, Barton SE, Murray A (2000) Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology (Oxford) 39(5):497–500

    Article  CAS  Google Scholar 

  56. Fink HA, Milavetz DL, Palermo L et al (2005) Fracture Intervention Trial Research Group. What proportion of incident radiographic deformities is clinically diagnosed and vice versa? J Bone Miner Res 20(7):1216–1222

    Article  PubMed  Google Scholar 

  57. Donnelly S, Doyle DV, Denton A, Rolfe I, McCloskey EV, Spector TD (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53(2):117–121

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. McCloskey EV, Spector TD, Eyers KS et al (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporosis Int 3(3):138–147

    Article  CAS  Google Scholar 

  59. Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford) 39(1):85–89

    Article  CAS  Google Scholar 

  60. Vosse D, van der Heijde D, Landewé R et al (2006) Determinants of hyperkyphosis in patients with ankylosing spondylitis. Ann Rheum Dis 65(6):770–774

    Article  CAS  PubMed  Google Scholar 

  61. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fractures assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148

    Article  CAS  PubMed  Google Scholar 

  62. Muñoz-Ortego J, Vestergaard P, Rubio JB et al (2014) Ankylosing spondylitis is associated with an increased risk of vertebral and nonvertebral clinical fractures: a population-based cohort study. J Bone Miner Res 29(8):1770–1776

    Article  PubMed  Google Scholar 

  63. Jun JB, Joo KB, Her MY et al (2006) Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 33(8):1637–1641

    PubMed  Google Scholar 

  64. Sivri A, Kilinc S, Gokce-Kutsal Y, Ariyurek M (1996) Bone mineral density in ankylosing spondylitis. Clin Rheumatol 15(1):51–54

    Article  CAS  PubMed  Google Scholar 

  65. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8(8):817–831

    Article  CAS  Google Scholar 

  66. Glace B, Dubost JJ, Ristori JM, Irthum B, Chazal J, Soubrier M (2011) Transversal fractures in spinal ankylosis: a case series of 17 patients. Rev Med Interne 32(5):283–286

    Article  CAS  PubMed  Google Scholar 

  67. Kouyoumdjian P, Guerin P, Schaelderle C, Asencio G, Gille O (2012) Fracture of the lower cervical spine in patients with ankylosing spondylitis: retrospective study of 19 cases. Orthop Traumatol Surg Res 98(5):543–551

    Article  CAS  PubMed  Google Scholar 

  68. Koivikko MP, Kiuru MJ, Koskinen SK (2004) Multidetector computed tomography of cervical spine fractures in ankylosing spondylitis. Acta Radiol 45(7):751–759

    Article  CAS  PubMed  Google Scholar 

  69. Karul M, Bannas P, Schoennagel BP et al (2013) Fractures of the thoracic spine in patients with minor trauma: comparison of diagnostic accuracy and dose of biplane radiography and MDCT. Eur J Radiol 82(8):1273–1277

    Article  CAS  PubMed  Google Scholar 

  70. Campagna R, Pessis E, Feydy A et al (2009) Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR 192(4):987–995

    Article  PubMed  Google Scholar 

  71. Koivikko MP, Koskinen SK (2008) MRI of cervical spine injuries complicating ankylosing spondylitis. Skelet Radiol 37(9):813–819

    Article  Google Scholar 

  72. Anwar F, Al Khayer A, Fraser M, Allan DB (2009) Concomitant cervical and thoracic spinal fractures in ankylosing spondylitis: a case report and review of literature. Injury Extra 40(11):242–245

    Article  Google Scholar 

  73. Gelalis ID, Lykissas MG, Dimou AA, Giannoulis DK, Beris AE (2015) Fatal isolated cervical spine injury in a patient with ankylosing spondylitis: a case report. Glob Spine J 5(3):253–256

    Article  Google Scholar 

  74. Bransford RJ (2015) Commentary on: “Fatal isolated cervical spine injury in a patient with ankylosing spondylitis: a case report”. Glob Spine J 5(3):257–258

    Article  Google Scholar 

  75. Papadopoulos MC, Chakraborty A, Waldron G, Bell BA (1999) Lesson of the week: exacerbating cervical spine injury by applying a hard collar. BMJ 319(7203):171–172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Maskery NS, Burrows N (2002) Cervical spine control; bending the rules. Emerg Med J 19(6):592–593

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C (2010) Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976) 35(11):E458–E464

    Article  Google Scholar 

  78. Elgafy H, Bransford RJ, Chapman JR (2011) Epidural hematoma associated with occult fracture in ankylosing spondylitis patient: a case report and review of the literature. J Spinal Disord Tech 24(7):469–473

    Article  PubMed  Google Scholar 

  79. Hentschel SJ, Woolfenden AR, Fairholm DJ (2001) Resolution of spontaneous spinal epidural hematoma without surgery: report of two cases. Spine (Phila Pa 1976) 26(22):E525–E527

    Article  CAS  Google Scholar 

  80. Börm W, Mohr K, Hassepass U, Richter HP, Kast E (2004) Spinal hematoma unrelated to previous surgery: analysis of 15 consecutive cases treated in a single institution within a 10-year period. Spine (Phila Pa 1976) 29(24):E555–E561

    Article  Google Scholar 

  81. Rowed DW (1992) Management of cervical spinal cord injury in ankylosing spondylitis: the intervertebral disc as a cause of cord compression. J Neurosurg 77(2):241–246

    Article  CAS  PubMed  Google Scholar 

  82. Young JS, Cheshire JE, Pierce JA, Vivian JM (1977) Cervical ankylosis with acute spinal cord injury. Paraplegia 15(2):133–146

    Article  CAS  PubMed  Google Scholar 

  83. Murray GC, Persellin RH (1981) Cervical fracture complicating ankylosing spondylitis: a report of eight cases and review of the literature. Am J Med 70(5):1033–1041

    Article  CAS  PubMed  Google Scholar 

  84. Hunter T, Dubo HI (1983) Spinal fractures complicating ankylosing spondylitis. A long-term followup study. Arthritis Rheum 26(6):751–759

    Article  CAS  PubMed  Google Scholar 

  85. Weinstein PR, Karpman RR, Gall EP, Pitt M (1982) Spinal cord injury, spinal fracture, and spinal stenosis in ankylosing spondylitis. J Neurosurg 57(5):609–616

    Article  CAS  PubMed  Google Scholar 

  86. Osgood C, Martin LG, Ackerman E (1973) Fracture-dislocation of the cervical spine with ankylosing spondylitis. Report of two cases. J Neurosurg 39(6):764–769

    Article  CAS  PubMed  Google Scholar 

  87. Chaudhary SB, Hullinger H, Vives MJ (2011) Management of acute spinal fractures in ankylosing spondylitis. ISRN Rheumatol. doi:10.5402/2011/150484

    PubMed  PubMed Central  Google Scholar 

  88. Charles YP, Buy X, Gangi A, Steib JP (2013) Fracture in ankylosing spondylitis after minor trauma: radiological pitfalls and treatment by percutaneous instrumentation. A case report. Orthop Traumatol Surg Res 99(1):115–119

    Article  CAS  PubMed  Google Scholar 

  89. Nayak NR, Pisapia JM, Abdullah KG, Schuster JM (2015) Minimally invasive surgery for traumatic fractures in ankylosing spinal diseases. Glob Spine J 5(4):266–273

    Article  Google Scholar 

  90. Detwiler KN, Loftus CM, Godersky JC, Menezes AH (1990) Management of cervical spine injuries in patients with ankylosing spondylitis. J Neurosurg 72(2):210–215

    Article  CAS  PubMed  Google Scholar 

  91. Moussellard H, Pointillart V, Mangione P, Shauwerbecke T, Vital JM, Sénégas J (1996) Spontaneous vertebral pseudarthrosis in ankylosing spondylitis. Apropos of 3 cases. Rev Chir Orthop Repar Appar Mot 82(5):453–457

    CAS  Google Scholar 

  92. Deburge A, Guigui P, Ouahes M, Barre E (1996) Cervical pseudarthrosis in ankylosing spondylitis. A case report. Spine (Phila Pa 1976) 21(23):2801–2805

    Article  CAS  Google Scholar 

  93. Mountney J, Murphy AJ, Fowler JL (2005) Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis. Eur Spine J 14(7):689–693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Hitchon PW, From AM, Brenton MD, Glaser JA, Torner JC (2002) Fractures of the thoracolumbar spine complicating ankylosing spondylitis. J Neurosurg 97(2 Suppl):218–222

    PubMed  Google Scholar 

  95. Knöringer P (1992) Osteosynthesis of injuries and rheumatic or congenital instabilities of the upper cervical spine using double-threaded screws. Neurosurg Rev 15(4):275–283

    PubMed  Google Scholar 

  96. Taggard DA, Traynelis VC (2000) Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation. Spine (Phila Pa 1976) 25(16):2035–2039

    Article  CAS  Google Scholar 

  97. Wong AS, Yu DH (2015) Cervical spine fracture in a patient with ankylosing spondylitis causing a C2-T9 spinal epidural hematoma—treatment resulted in a rapid and complete recovery from tetraplegia: case report and literature review. Asian J Neurosurg 10(1):53

    PubMed  PubMed Central  Google Scholar 

  98. Payer M (2006) Surgical management of cervical fractures in ankylosing spondylitis using a combined posterior-anterior approach. J Clin Neurosci 13(1):73–77

    Article  CAS  PubMed  Google Scholar 

  99. Teyssédou S, Saget M, Prébet R, Leclercq N, Vendeuvre T, Pries P (2012) Evaluation of percutaneous surgery in the treatment of thoracolumbar fractures. Preliminary results of a prospective study on 65 patients. Orthop Traumatol Surg Res 98(1):39–47

    Article  PubMed  Google Scholar 

  100. Geusens P, Emans PJ, de Jong JJ, van den Bergh J (2013) NSAIDs and fracture healing. Curr Opin Rheumatol 25(4):524–531

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Radiology, School of Medicine, Catholic University, Largo A. Gemelli 1, 00168, Rome, Italy

    Antonio Leone, Marzia Marino, Claudia Dell’Atti, Viola Zecchi, Nicola Magarelli & Cesare Colosimo

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  1. Antonio Leone
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  2. Marzia Marino
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Leone, A., Marino, M., Dell’Atti, C. et al. Spinal fractures in patients with ankylosing spondylitis. Rheumatol Int 36, 1335–1346 (2016). https://doi.org/10.1007/s00296-016-3524-1

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Keywords

  • Ankylosing spondylitis
  • Ankylosing spondylitis, vertebral fractures
  • Ankylosing spondylitis, radiography
  • Ankylosing spondylitis, CT
  • Ankylosing spondylitis, magnetic resonance imaging