Clinical outcomes following spinal fracture in patients with ankylosing spondylitis

Abstract

Background

Ankylosing spondylitis is a seronegative rheumatoid condition mainly affecting the axial skeleton. It leads to progressive deformity and stiffening of the spine with an increased risk of vertebral fractures and significant neurological deficits compared to the general population.

Aim

This study aimed to evaluate the outcomes of patients with ankylosing spondylitis who sustained acute vertebral fractures over a 10-year period.

Methods

A retrospective review of patient records and radiographic images was performed. Mechanism of injury, fracture type, timing of diagnosis, neurological deficit, management and complications were assessed.

Results

Twenty-four patients were included. Most (23) sustained low energy injuries. Five (20%) patients had a delayed diagnosis over 24 h after the time of injury. Twelve (50%) of patients had a neurological deficit at the time of admission and most did not recover. Eighteen (75%) patients underwent surgical stabilisation. There were 19 complications (in 15 patients) following surgery.

Conclusion

Patients with ankylosing spondylitis are at risk of spinal fracture and associated spinal cord injury after relatively minor trauma. Delayed diagnosis places the patient at risk of neurological compromise, and thus a high index of suspicion is needed when assessing this patient group.

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References

  1. 1.

    Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369(9570):1379–1390

    Article  PubMed  Google Scholar 

  2. 2.

    van der Linden SM, Valkenburg HA, de Jongh BM, Cats A (1984) The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population. Arthritis Rheum 27(3):241–249

    Article  PubMed  Google Scholar 

  3. 3.

    Braun J, Bollow M, Remlinger G et al (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41(1):58–67

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    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

    CAS  Article  Google Scholar 

  5. 5.

    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

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Singh HJ, Nimarpreet K, Ashima, Das S, Kumar A, Prakash S (2013) Study of bone mineral density in patients with ankylosing spondylitis. J Clin Diagn Res 7(12):2832–2835

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Klingberg E, Geijer M, Gothlin 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 

  8. 8.

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

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    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 

  10. 10.

    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

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Badve SA, Bhojraj SY, Nene AM et al (2010) Spinal instability in ankylosing spondylitis. Indian J Orthop 44(3):270–276

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Graham GP, Evans PD (1991) Spinal fractures in patients with ankylosing spondylitis. Injury 22(5):426–427

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    International Standards for the Neurological Classification of Spinal Cord Injury, Revised 2015 [booklet]. Atlanta, GA: American Spinal Injury Association

  14. 14.

    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 

  15. 15.

    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 

  16. 16.

    An SB, Kim KN, Chin DK, Kim KS, Cho YE, Kuh SU (2014) Surgical outcomes after traumatic vertebral fractures in patients with ankylosing spondylitis. J Korean Neurosurg Soc 56(2):108–113

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Robinson Y, Sanden B, Olerud C (2013) Increased occurrence of spinal fractures related to ankylosing spondylitis: a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden. Patient Saf Surg 7(1):2

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    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

    CAS  Article  Google Scholar 

  19. 19.

    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

    Article  PubMed  Google Scholar 

  20. 20.

    Feldtkeller E, Lind-Albrecht G, Rudwaleit M (2013) Core set of recommendations for patients with ankylosing spondylitis concerning behaviour and environmental adaptations. Rheumatol Int 33(9):2343–2349

    Article  PubMed  Google Scholar 

  21. 21.

    Sapkas G, Kateros K, Papadakis SA et al (2009) Surgical outcome after spinal fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord 10:96

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Westerveld LA, van Bemmel JC, Dhert WJ, Oner FC, Verlaan JJ (2014) Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J 14(5):729–740

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Lukasiewicz AM1, Bohl DD, Varthi AG, Basques BA, Webb ML, Samuel AM, Grauer JN (2016) Spinal Fracture in Patients With Ankylosing Spondylitis: Cohort Definition, Distribution of Injuries, and Hospital Outcomes. Spine (Phila Pa 1976) 41(3):191–6

  24. 24.

    Robinson Y, Willander J, Olerud C (2015) Surgical stabilization improves survival of spinal fractures related to ankylosing spondylitis. Spine (Phila Pa 1976) 40(21):1697–1702

    Article  Google Scholar 

  25. 25.

    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

    CAS  Article  Google Scholar 

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Correspondence to M. Nugent.

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The authors received no funding for this work and declare no conflict of interest. As this was a retrospective study and involved no intervention or change in treatment, consent was not necessary.

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Nugent, M., Berney, M.J. & Morris, S. Clinical outcomes following spinal fracture in patients with ankylosing spondylitis. Ir J Med Sci 186, 677–681 (2017). https://doi.org/10.1007/s11845-017-1566-3

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Keywords

  • Ankylosing spondylitis
  • Spinal fracture
  • Trauma
  • Outcomes
  • Spinal cord injury