Skip to main content

Advertisement

SpringerLink
Log in

A retrospective study of treating thoracolumbar spine fractures in ankylosing spondylitis

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  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):117–121

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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):1877–1882

    CAS  PubMed  Google Scholar 

  3. Hunter T, Dubo H (1978) Spinal fractures complicating ankylosing spondylitis. Ann Intern Med 88(4):546–549

    Article  CAS  PubMed  Google Scholar 

  4. 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 

  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. 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

    Article  PubMed Central  PubMed  Google Scholar 

  7. Hosssain M, McLean A, Fraser MH (2004) Outcome of halo immobilisation of 104 cases of cervical spine injury. Scott Med J 49(3):90–92

    CAS  PubMed  Google Scholar 

  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):157–160

    PubMed  Google Scholar 

  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):S1–133

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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)

    PubMed  Google Scholar 

  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

    Article  PubMed Central  PubMed  Google Scholar 

  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):218–222

    PubMed  Google Scholar 

  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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Feltelius N, Hedenstrom H, Hillerdal G, Hallgren R (1986) Pulmonary involvement in ankylosing spondylitis. Ann Rheum Dis 45(9):736–740

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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. 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

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Meng-Ling Lu, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu, Chi-Chien Niu, Lih-Huei Chen & Wen-Jer Chen

  2. Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan

    Tsung-Ting Tsai

Authors
  1. Meng-Ling Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsung-Ting Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Po-Liang Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tsai-Sheng Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chi-Chien Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lih-Huei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wen-Jer Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lih-Huei Chen.

Additional information

Meng-Ling Lu and Tsung-Ting Tsai have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lu, ML., Tsai, TT., Lai, PL. et al. A retrospective study of treating thoracolumbar spine fractures in ankylosing spondylitis. Eur J Orthop Surg Traumatol 24 (Suppl 1), 117–123 (2014). https://doi.org/10.1007/s00590-013-1375-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1375-y

Keywords

Search

Navigation