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Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis

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Abstract

Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine fractures. Long-standing pain may mask the symptoms of the fracture. Radiological imaging of the cervical spine may fail to identify the fracture due to the distorted anatomy, ossified ligaments and artefacts leading to delay in diagnosis and increased risk of neurological complications. The objectives are to identify the incidence and risk factors for delay in presentation of cervical spine fractures in patients with AS. Retrospective case series study of all patients with AS and cervical spine fracture admitted over a 12-year period at Queen Elizabeth National Spinal Injuries Unit, Scotland. Results show that total of 32 patients reviewed with AS and cervical spine fractures. In 19 patients (59.4%), a fracture was not identified on plain radiographs. Only five patients (15.6%) presented immediately after the injury. Of the 15 patients (46.9%) who were initially neurologically intact, three patients had neurological deterioration before admission. Cervical spine fractures in patients with long-standing AS are common and usually under evaluated. Early diagnosis with appropriate radiological investigations may prevent the possible long-term neurological cord damage.

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References

  1. Mansour M, Cheema GS, Naguwa SM, Greenspan A, Borchers AT, Keen CL, Gershwin ME (2007) Ankylosing spondylitis: a contemporary perspective on diagnosis and treatment. Semin Arthritis Rheum 36:210–233

    Article  PubMed  Google Scholar 

  2. Mundwiler M, Siddique K, Dym J et al (2008) Complications of the spine in ankylosing spondylitis with a focus on deformity correction. Neurosurg Focus 24:1–9

    Article  Google Scholar 

  3. Geusens P, Vosse D, Van der Liden S (2007) Osteoprosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19:335–339

    Article  PubMed  Google Scholar 

  4. Garrison A, Clifford K, Gleason SF, Tun CG, Brown R, Garshick E (2004) Alcohol use associated with cervical spinal cord injury. J Spinal Cord Med 27:111–115

    PubMed  Google Scholar 

  5. Gran JT, Skomsvoll JF (1997) The outcome of ankylosing spondylitis. Br J Rheumatol 36:766–771

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  7. Ditunno JF, Young W, Donovan WH, Creasey G (1994) The international standards booklet for neurological and functional classification of spinal cord injury. Americal Spinal Injury Association. Paraplegia 32:70–80

    PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Detwiller KN, Loftus CM, Godersky JC, Menzes AH (1989) Management of spine injuries in patients with ankylosing spondylitis. J Neurosurg 72:210–215

    Google Scholar 

  10. Alaranta H, Luoto S, Konittinen YT (2002) Traumatic spinal cord injury as a complication to ankylosing spondylitis. Clin Exp Rheumatol 20:66–68

    PubMed  CAS  Google Scholar 

  11. Hunter T, Dubo H (1978) Spinal fractures complicating ankylosing spondylitis. Ann Intern Med 88:546–549

    PubMed  CAS  Google Scholar 

  12. Foo D, Sarkarati M, Marcelino V (1985) Cervical spinal cord injury complicating ankylosing spondylitis. Paraplegia 23:358–363

    PubMed  CAS  Google Scholar 

  13. Iplikcioglu AC, Bayar MA, Kokes F, Gokcek C, Doganay OS (1994) Magnetic resonance imaging in cervical trauma associated with ankylosing spondylitis: report of two cases. J Trauma 36:412–413

    Article  PubMed  CAS  Google Scholar 

  14. Smartizis D, Anderson DG, Shen FH (2005) Multiple and simultaneous spine fractures in ankylosing spondylitis. Spine 30:711–715

    Article  Google Scholar 

  15. Olerud C, Andersson S, Svensson B, Bring J (1999) Cervical spine fractures in the elderly: factors influencing survival in 65 cases. Acta Orthop Scand 70:509–513

    Article  PubMed  CAS  Google Scholar 

  16. Myllykangas-Lousujarvu R, Aho K, Lehtinen K, Kautiainen H, Hakala M (1996) Increased incidence of alcohol related deaths from accidents and violence in subjects with ankylosing spondylitis. Eur Spine J 5:51–55

    Article  Google Scholar 

  17. 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 40:242–245

    Article  Google Scholar 

  18. Burke DA, Linden RD, Zhang YP, Meiste AC, Shields CB (2001) Incidence rates and populations at risk for spinal cord injury: a regional study. Spinal Cord 39:274–278

    Article  PubMed  CAS  Google Scholar 

  19. Sekhon LH, Fehlings MG (2001) Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 26:S2–S12

    Article  PubMed  CAS  Google Scholar 

  20. Graham B, Pereghem K (1989) Fractures of the spine in ankylosing spondylitis. Spine 14:801–807

    Google Scholar 

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Authors and Affiliations

  1. Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK

    Fahim Anwar, A. Al-Khayer, G. Joseph, M. H. Fraser, M. V. Jigajinni & D. B. Allan

  2. 9 Rowan Court, Cambuslang, Glasgow, G72 7FX, UK

    Fahim Anwar

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  1. Fahim Anwar
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  2. A. Al-Khayer
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  3. G. Joseph
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  4. M. H. Fraser
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  5. M. V. Jigajinni
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  6. D. B. Allan
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Correspondence to Fahim Anwar.

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Anwar, F., Al-Khayer, A., Joseph, G. et al. Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis. Eur Spine J 20, 403–407 (2011). https://doi.org/10.1007/s00586-010-1628-y

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  • DOI: https://doi.org/10.1007/s00586-010-1628-y

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