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A retrospective study of treating thoracolumbar spine fractures in ankylosing spondylitis

  • Meng-Ling Lu
  • Tsung-Ting Tsai
  • Po-Liang Lai
  • Tsai-Sheng Fu
  • Chi-Chien Niu
  • Lih-Huei ChenEmail author
  • Wen-Jer Chen
Original Article

Abstract

Spinal fractures are commonly encountered in ankylosing spondylitis (AS) patients. This study compares the outcome of early surgical treatment with initial conservative treatment for thoracolumbar fractures in patients with AS. From 1996 to 2008, 28 patients with AS were treated either operatively or conservatively for thoracolumbar fractures; however, only 25 patients met the inclusion criteria with a minimum follow-up of 2 years. For surgically treated patients, posterior spinal instrumentation was performed using a transpedicle screw system. Nonsurgically treated patients wore a fracture brace. The demographic data, diagnosis, mechanism of injury, and neurological status were recorded, and fracture healing was assessed radiographically. The mean age was 54.2 ± 13.8 years (range 30–80 years). Six patients (Group A) received surgical intervention within 1 month. All of these fractures healed, and two of five patients showed neurologic improvement after surgery. Eight patients (Group B) had fractures that were missed. The delay in diagnosis resulted in pseudoarthrosis in all cases, and progressive neurologic deficits were identified in four cases. Eleven patients (Group C) received conservative treatment with bracing. Fracture union was achieved in three cases, and pseudoarthrosis occurred in eight cases. Operative treatment can achieve solid fusion and improve the neurological status, while conservative treatment may result in pseudoarthrosis and progressive neurologic deficit. The results suggest that AS patients with unstable spinal fractures should receive early surgical management to prevent further sequelae.

Keywords

Ankylosing spondylitis Spinal fractures Posterior instrumentation Fracture bracing Surgical versus conservative treatment 

References

  1. 1.
    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):117–121PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    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):1877–1882PubMedGoogle Scholar
  3. 3.
    Hunter T, Dubo H (1978) Spinal fractures complicating ankylosing spondylitis. Ann Intern Med 88(4):546–549PubMedCrossRefGoogle Scholar
  4. 4.
    Hunter T, Dubo HI (1983) Spinal fractures complicating ankylosing spondylitis. A long-term followup study. Arthritis Rheum 26(6):751–759PubMedCrossRefGoogle Scholar
  5. 5.
    Chaudhary SB, Hullinger H, Vives MJ (2011) Management of acute spinal fractures in ankylosing spondylitis. ISRN Rheumatol 2011:Article ID 150484. doi: 10.5402/2011/150484
  6. 6.
    Anwar F, Al-Khayer A, Joseph G, Fraser MH, Jigajinni MV, Allan DB (2011) Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis. Eur Spine J 20(3):403–407. doi: 10.1007/s00586-010-1628-y PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Hosssain M, McLean A, Fraser MH (2004) Outcome of halo immobilisation of 104 cases of cervical spine injury. Scott Med J 49(3):90–92PubMedGoogle Scholar
  8. 8.
    Farrokhi MR, Motallebi H (2007) Outcome of surgical and nonsurgical methods in the treatment of unstable traumatic lesions of the lower cervical spine. Arch Iran Med 10(2):157–160PubMedGoogle Scholar
  9. 9.
    Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium-2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–133PubMedCrossRefGoogle Scholar
  10. 10.
    Jacobs WB, Fehlings MG (2008) Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance. Neurosurg Focus 24(1):E12. doi: 10.3171/FOC/2008/24/1/E12 PubMedCrossRefGoogle Scholar
  11. 11.
    Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C (2010) Spine fractures in patients with ankylosing spinal disorders. Spine 35(11):E458–464. doi: 10.1097/BRS.0b013e3181cc764f (Phila Pa 1976)PubMedGoogle Scholar
  12. 12.
    Sapkas G, Kateros K, Papadakis SA, Galanakos S, Brilakis E, Machairas G, Katonis P (2009) Surgical outcome after spinal fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord 10:96. doi: 10.1186/1471-2474-10-96 PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Hitchon PW, From AM, Brenton MD, Glaser JA, Torner JC (2002) Fractures of the thoracolumbar spine complicating ankylosing spondylitis. J Neurosurg 97(2 Suppl):218–222PubMedGoogle Scholar
  14. 14.
    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. doi: 10.1007/s00586-008-0764-0 PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Feltelius N, Hedenstrom H, Hillerdal G, Hallgren R (1986) Pulmonary involvement in ankylosing spondylitis. Ann Rheum Dis 45(9):736–740PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Momeni M, Taylor N, Tehrani M (2011) Cardiopulmonary manifestations of ankylosing spondylitis. Int J Rheumatol 2011:Article ID 728471. doi: 10.1155/2011/728471
  17. 17.
    Fox MW, Onofrio BM, Kilgore JE (1993) Neurological complications of ankylosing spondylitis. J Neurosurg 78(6):871–878. doi: 10.3171/jns.1993.78.6.0871 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Meng-Ling Lu
    • 1
  • Tsung-Ting Tsai
    • 1
    • 2
  • Po-Liang Lai
    • 1
  • Tsai-Sheng Fu
    • 1
  • Chi-Chien Niu
    • 1
  • Lih-Huei Chen
    • 1
    Email author
  • Wen-Jer Chen
    • 1
  1. 1.Department of Orthopaedic Surgery, Spine SectionChang Gung Memorial Hospital and College of Medicine, Chang Gung UniversityTaoyuanTaiwan
  2. 2.Graduate Institute of Clinical Medical SciencesChang Gung UniversityTaoyuanTaiwan

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