Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

Cervical spine fractures in patients with ankylosing spondylitis are serious and potentially lethal injuries with high complication rates. Treatment obstacles include long lever arms that generate large forces on any fixation device, osteoporosis, and, usually, kyphotic deformity. The Olerud Cervical Fixation System (OC), with cervical pedicle screws and rods, offers an opportunity to create a biomechanically stable posterior fixation in these complicated cases. The present study is a retrospective chart review and a radiological follow-up of patients with this diagnosis, treated at our department between 1995 and 2000. Nineteen patients (two women) with a mean age of 60 years (32–78 years) were included. The fracture levels were predominantly C5–C6 (five patients) and C6–C7 (five patients). All patients were treated with a long posterior fixation with the OC, and in four patients this was combined with an anterior plate fixation. One patient with severe lordosis also received a short posterior plate fixation. The patients notes and plain radiographs have been reviewed. Five patients died during the post-operative follow-up period; the others had a mean follow-up time of 24 months (10–55 months). Eleven patients had no neurological deficits preoperatively. One of them developed moderate weakness in his right arm, postoperatively, due to a misplaced pedicle screw in the right pedicle of C5. However, after extraction of the screw he almost totally recovered in 6 months. Eight patients had neurological deficits. Two were paraplegic; two had motor weakness combined with sensory deficiency, and four had a sensory deficiency. Two of the patients with neurological deficits improved postoperatively, but the others were unchanged. Peroperative problems were recorded in five patients; one C6 pedicle was perforated, and two patients had pedicles on one or more levels that the surgeon was not able to probe. In one of the latter patients, transfacet screws were chosen, instead, for one of the levels. Extensive peroperative bleeding was encountered in two patients. One deep-wound infection was noted, postoperatively, and required surgical drainage, but no patients have been re-operated due to loosening of the instrument or to healing problems. In conclusion, the results of the present study indicate that the OC—and possibly other similar long-fixation systems that allow using both pedicle screws and lateral mass screws rigidly connected to a rod—is suited for treating subaxial cervical spine fractures in patients with ankylosing spondylitis, allowing high healing rates.     

强直性脊柱炎患者颈椎新鲜骨折的临床特征及术式选择

目的 :探讨强直性脊柱炎(AS)患者颈椎新鲜骨折的临床特征及手术策略。方法:回顾性分析2002年2月~2014年10月我科收治的15例AS颈椎新鲜骨折患者的临床资料,其中男14例,女1例,年龄36~76岁,平均49.7±10.8岁。13例有明确外伤史,其中4例为高能量损伤;经椎间隙和经椎体骨折分别为8例和7例,14例累及C5~C7节段;12例(80%)伴神经功能损害。12例接受手术治疗,7例前柱广泛破坏者行前路椎间盘切除或椎体次全切除、内固定植骨融合术;3例脊髓后方受压、前柱轴向承载功能保持良好的患者行后路椎板减压内固定融合术;2例严重骨折脱位不稳定患者行前后路联合手术。采用ASIA分级评估患者手术前后神经功能状态,摄颈椎X线片观察植骨融合情况。结果:除3例未手术患者外,余患者均获得随访,随访时间3~60个月(20.0±18.8个月),除1例术前ASIA A级及2例ASIA D级患者外,其余患者术后神经功能均获明显改善,末次随访时骨折部位骨性融合。围手术期并发症包括脑脊液漏1例,喉返神经损伤1例,前路术后切口深部感染1例。随访中无骨折不愈合、假关节形成及内固定失败。结论:AS颈椎新鲜骨折好发于下颈椎,伤后神经系统并发症发生率较高,应积极手术治疗稳定脊柱;前柱明显破坏患者选择单纯前路手术,前柱轴向承载功能尚可者行单纯后路手术,严重颈椎骨折脱位患者应行前后路联合手术。     

Iatrogenic fractures in ankylosing spondylitis—a report of two cases

Study design: Two cases of intraoperative, iatrogenic cervical spine fractures in patients with ankylosing spondylitis are reported. Objective: To describe the uncommon complication of iatrogenic cervical spine fractures occurring during spine surgery in patients with ankylosing spondylitis. Summary of background data: To our knowledge, this is the first report on this rare complication. Methods: A 39-year-old patient (1) with ankylosing spondylitis was operated on for cervical stenosis due to C1/2 anterolisthesis. Fifteen hours postoperatively, he developed acute quadriplegia. MRI revealed a fracture/dislocation of C6 on C7 and compression of the spinal cord at this level. Revision was performed with decompression and instrumentation from the occiput to T3. A 55-year-old patient (2) with ankylosing spondylitis and thoracic hyperkyphosis underwent a correction procedure consisting of costotransversectomy, anterior cage implantation at T8/9, and posterior instrumentation from T4 to L1. Halo traction was temporarily applied for correction. At the end of the operation, with the patient still under anesthesia, increased mobility of the cervical spine was noticed. Emergent MRI revealed a fracture of the anterior structures of C6/7. Posterior instrumentation from C5 to T1 was then performed. Results: Quadriplegia persisted in patient 1 until his death secondary to further complications. Patient 2 was mobilized without any neurologic deficits. The fracture healed in good alignment. Conclusions: Iatrogenic fractures of the cervical spine during surgery in ankylosing spondylitis patients are a rare but potentially severe complication. Early diagnosis and therapy are necessary before dislocation, cord compression, and subsequent neurologic impairment occur.     

颈僵硬畸形的强直性脊柱炎患者并颈椎骨折脱位的手术入路选择

目的：探讨颈椎已僵硬畸形的强直性脊柱炎患者合并外伤性颈椎骨折脱位的合理手术入路.方法：回顾分析2000年3月至2004年3月收治的12例颈椎强直性脊柱炎合并外伤性颈椎骨折脱位患者的临床资料.10例合并不完全性瘫痪,1例完全性瘫痪.3例行前路手术未能纠正脱位而行椎体次全切除减压植骨融合钢板内固定;2例先行前路手术,发现无法复位而立即改为后路手术完成复位、固定后再经前路减压、融合;另7例均先经后路完成脱位复位、侧块固定融合,然后再经前路行减压融合.结果：3例仅行前路内固定者于术后第3～7天发现钢板松动移位,行后路翻修术,通过后路完成了复位固定;9例先行后路手术再行前路融合者均顺利完成脱位复位及固定融合.随访3个月～4年,10例不完全性瘫痪患者2例恢复到伤前水平,8例恢复部分功能;1例完全性瘫痪者术后半年无改善,死于并发症.结论：对于颈椎已发生僵硬畸形的强直性脊柱炎患者发生外伤性骨折脱位时应先经后路复位固定融合,然后再一期行前路减压和植骨融合.     

Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis

This case report illustrates three learning points about cervical fractures in ankylosing spondylitis, and it highlights the need to manage these patients with the neck initially stabilised in flexion. We describe a case of cervical pseudoarthrosis that is a rare occurrence after fracture of the cervical spine with ankylosing spondylitis. This went undetected until the development of myelopathic symptoms many months later. The neck was initially stabilised in flexion using tongs, and then slowly extended before anterior and posterior fixation was performed. The myelopathic symptoms resolved, and the patient had a good result at 18 months. We conclude that any increased movement of the spine after trauma in ankylosing spondylitis must be considered suspect and fully investigated.     

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

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.     

强直性脊柱炎颈椎骨折的手术治疗

目的研究强直性脊柱炎颈椎骨折或骨折脱位手术治疗的疗效、融合率及相关问题。方法回顾性研究1986年4月～2004年4月手术治疗的12例累及颈椎的强直性脊柱炎合并颈椎骨折或骨折脱位患者。采用美国脊柱损伤学会(ASIA)神经功能障碍评分进行神经功能评价,应用图形分析软件(Image-Pro Plus5．1)分别测量屈曲和仰伸位融合节段上下椎成角,计算两个角度的差值(作为椎间的运动参数,α角),按照美国食品药品监督管理局(FDA)对脊柱融合的定义,α角≥4°认为假关节形成(不融合)。对与手术有关的其它问题采用描述性研究。结果12例患者获得21～124个月(平均67．5个月)随访。9例神经损伤患者ASIA评分平均改善1．3级,除1例前路手术未行内固定外,所有融合手术均行内固定。前路融合术6例,α角为0°；后路融合术2例,α角为0～2．5°；联合前后路融合术1例,随访时均获骨性融合。3例拟行椎板成形术者,2例因“门轴”侧骨折被迫行椎板切除术。术后并发症：气胸、肺不张1例,经胸腔闭式引流5 d治愈；伤口延迟愈合1例；前路伤口内积血1例,经切开引流治愈。无死亡及严重并发症发生。结论强直性脊柱炎颈椎骨折或骨折脱位行手术治疗可以改善神经功能；对不稳定损伤,融合手术应行内固定,可以达到骨性融合；术前由于合并症多导致手术耐受性差,术后并发症多发。     

颈椎小关节评估在改良型Stoke强直性脊柱炎脊柱评分体系中对评估强直性脊柱炎的影像学进展的研究

目的探讨颈椎小关节评估在改良型Stoke强直性脊柱炎脊柱评分体系(modified Stoke ankylosing spondylitis spine score,m SASSS)中对强直性脊柱炎患者(ankylosing spondylitis,AS)的影像学进展评估的临床诊断价值。方法收集了我院2010年1月-2014年12月期间收治的65例强直性脊柱炎患者。每个患者在随访前及随访过程中进行脊柱影像学检查,并根据m SASSS评分体系评估患者脊柱椎体的整体情况,以及增加针对颈椎小关节的影像学评估体系,通过计算两部分评分总和,即为我们定义的混合型改良脊柱评分(combined modified AS spine socre,cmASSS),并评价cmASSS评分体系的临床应用价值。结果在65例AS患者中,其中有58例完成的cmASSS评分。在随访前的影像学检查中通过cmASSS评分体系发现有69.0%的患者存在脊柱损伤的影像学改变,而m SASSS评分体系仅诊断50.0%的患者存在脊柱损伤(P=0.038)。随访观察期内通过影像学对疾病进展评估后发现,cmASSS评分体系中有60.3%的患者存在疾病进展,而m SASSS仅发现41.4%的患者存在疾病进展(P=0.041)。根据斯皮尔曼等级相关分析,cmASSS评分与AS患者的颈椎旋转、枕墙距、脊柱侧弯、胸廓扩张等脊柱活动度指标和AS功能指数的相关性优于m SASSS评分。结论在m SASSS基础上整合颈椎小关节评估有助于更全面、及时地诊断AS患者的脊柱损伤情况和脊柱损伤进展或转归,为AS的治疗、预后评估提供指导。     

Cervical osteotomy in ankylosing spondylitis: evaluation of new developments

Objectives: Cervical osteotomy can be performed on patients with cervical kyphosis due to ankylosing spondylitis. This study reviews the role of two new developments in cervical osteotomy surgery: internal fixation and transcranial electrical stimulated motor evoked potential monitoring (TES-MEP). Methods: From 1999 to 2004, 16 patients underwent a C7-osteotomy with internal fixation. In 11 patients, cervical osteotomy was performed in a sitting position with halo-cast immobilization (group S), five patients underwent surgery in prone position with Mayfield clamp fixation (group P). In group P, longer fusion towards T4-T6 could be obtained that created a more stable fixation. Therefore, post-operative immobilization protocol of group P was simplified from halo-cast to cervical orthosis. Results: Consolidation was obtained in all patients without loss of correction. Post-operative chin-brow to vertical angle measured 5° (range 0–15). TES-MEP was successfully performed during all surgical procedures. In total, nine neurological events were registered. Additional surgical intervention resulted in recovery of amplitudes in six of nine events. In two patients spontaneous recovery took place. One patient showed no recovery of amplitudes despite surgical intervention and a partial C6 spinal cord lesion occurred. Conclusion: We conclude that C7 osteotomy with internal fixation has been shown to be a reliable and stable technique. When surgery is performed the in prone position, distal fixation can be optimally obtained allowing post-operative treatment by cervical orthosis instead of a halo-cast. TES-MEP monitoring has been shown to be a reliable neuromonitoring technique with high clinical relevancy during cervical osteotomy because it allows timely intervention before occurrence of permanent cord damage in a large proportion of the patients.     

强直性脊柱炎颈椎骨折的治疗

目的：探讨强直性脊柱炎（AS）患者颈椎骨折的治疗方法及效果。方法：回顾分析1990年1月～2003年12月收治的20例AS合并颈椎骨折患者，7例采用非手术治疗，1例采用前路AO钢板内固定，5例采用前后路联合固定，2例行后路侧块螺钉内固定，5例采用颈椎椎弓根螺钉固定。手术组术前Frankel分级A级3例．B级5例，C级3例，D级1例，E级1例；非手术组术前Frankel分级A级2例，B级2例，C级1例，E级2例。结果：非手术组中5例有神经症状者3例死亡．2例无恢复；平均4．8个月获得骨性融合。手术组中1例行前路手术者，术后第3天钢板脱出，改行前后路联合内固定融合；5例前后路联合内固定患者中，1例术中牵拉致喉返神经损伤，术后3个月自行恢复，1例死亡，其余患者术后平均3．4个月骨性融合。2例后路侧块螺钉同定者术后平均4．1个月骨性融合。5例行颈椎弓根螺钉固定者术后平均3．6个月骨性融合。手术组12例有神经症状者中1例死亡，9例有不同程度的改善。结论：AS伴颈椎骨折采用非手术治疗术后神经损伤症状无明显改善，且存在复位困难、外固定不牢、易出现肺部感染等并发症。手术治疗可稳定脊柱、解除压迫及早期康复锻炼，可减少长期应用外固定及卧床所致的并发症。     

强直性脊柱炎胸腰椎后凸畸形患者颈椎活动受限的相关因素及临床意义

目的:探讨强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形患者颈椎活动受限的相关因素及临床意义.方法:从2012年5月～2012年10月在我院就诊的51例AS胸腰椎后凸畸形患者中,筛选出资料完整的患者38例,其中男36例,女2例;年龄17～53岁,平均32.6岁;病程3～37年,平均10.1年.收集患者的年龄、病程、血沉(ESR)、C反应蛋白(CRP)、全脊柱后凸最大Cobb角(global kyphosis,GK)、颈椎病变评分(mSASSS)、颈椎曲度、C2～C7矢状面平衡(SVA)、AS疾病活动性量表(bath ankylosing spondylitis diseaseactivity index,BASDAI)、AS功能量表(bath ankylosing spondylitis functional index,BASFI)和Oswestry功能障碍指数(ODI).根据颈椎活动度(cervical range of motion,CROM)测量结果分组:A组,CROM＞40°;B组,CROM＜20°.采用独立t检验,比较两组间上述各参数的差异性.对于有差异的参数采用Pearson相关性检验分析其与CROM之间的相关性,寻找CROM的高危因素.结果:A组16例,CROM为41°～92°,平均65.8°±14.3°;B组17例,CROM为1°～19°,平均9.2°±6.6°.两组病程、BASFI、GK、mSASSS、颈椎曲度及C2～C7 SVA有显著性差异(P＜0.05),而年龄、ODI、BASDAI、ESR、CRP无显著性差异(P＞0.05).病程、颈椎mSASSS、颈椎曲度、C2～C7 SVA及BASFI与CROM均有显著相关性(r分别为-0.524、-0.895、0.494、-0.813、-0.501,P＜0.05),GK与CROM无显著相关性(r=-0.275,P=0.122).结论:较长病程和颈椎结构性损害是AS颈椎活动受限的主要相关因素,AS颈椎活动受限显著降低了患者的生活质量.     

术前头环背心复位固定在颈椎骨折脱位合并强直性脊柱炎患者中的临床应用

目的：探讨颈椎骨折脱位合并强直性脊柱炎（AS）患者术前应用头环背心（Halo vest）复位固定的有效性及安全性。方法：回顾性分析2012年1月～2019年1月我院23例术前行头环背心复位固定的颈椎骨折脱位合并AS患者的临床资料,其中男性22例,女性1例,年龄39～64岁（53.0±7.4岁）。患者损伤平面C2/3 1例,C4/5 5例,C5/6 13例,C6/7 1例,跨椎节斜形骨折3例（C4-C5椎体2例,C5-C6椎体1例）。术后随访12～36个月,平均22.4±7.7个月。所有患者入院诊断明确后采用头环背心进行复位、固定,直至手术结束。固定前后行颈椎侧位X线片评估复位效果,记录术前术中有无骨折断端再脱位、继发性神经功能恶化。所有患者骨折复位后行单纯后路或者前后联合入路植骨融合内固定术,记录手术时间、出血量及相关并发症。术前及末次随访采用美国脊柱损伤协会（ASIA）分级标准评估患者神经功能情况,并记录椎体融合时间。结果：应用头环背心17例患者获得解剖复位,4例复位满意,2例复位失败,复位失败患者手术前全身麻醉状态下再次进行复位获得解剖复位。固定治疗期间患者均未出现骨折断端再脱位或...     

强直性脊柱炎颈椎骨折诊断及后路内固定治疗

目的:探讨强直性脊柱炎颈椎骨折的临床特点,并应用后路侧块钢板内固定治疗强直性脊柱炎颈椎骨折。方法:对本院收治的14例强直性脊柱炎颈椎骨折病人行颈椎后路减压侧块内固定术,并根据住院资料及出院后随访,进行回顾性分析,总结其临床特点,观察神经功能恢复、骨折愈合及并发症情况。结果:强直性脊柱炎颈椎骨折病人约占所有颈椎骨折病人的3.5％,AS病史平均23年,好发于C_(6～7),其次为C_(5～6)。后路减压侧块固定操作简单,经术后平均23个月随访无神经功能恶化,Frankel分级较术前平均改善1级,骨折愈合良好,愈合时间平均3.5个月,并发症少。结论:强直性脊柱炎颈椎骨折好发于下颈椎椎间隙,容易漏诊迟诊,全面的影像学检查是诊断关键。受伤外力较小,脊髓损伤的发生率较高,后路减压侧块钢板内固定术治疗是一种有效的治疗方法。     

强直性脊柱炎并发椎间假关节形成的病理病因和治疗

目的：探讨强直性脊柱炎并发椎间假关节形成的病理病因及治疗方法。方法：对我院1995年～2002年治疗的23例并发假关节的强直性脊柱炎患者的临床资料、病理变化和治疗方法进行回顾性分析。结果：保守治疗13例，手术治疗10例。其中7例行前路椎间融合固定，3例行后路椎间融合固定。经随访观察，假关节全部获得骨性融合，症状缓解。结论：假关节形成是强直性脊柱炎不常见的并发症，与外伤和异常应力有直接关系。对保守治疗无效和出现神经症状的病例行前路或后路椎间植骨融合固定手术治疗效果满意。     

Cervical spine fractures in patients with ankylosing spondylitis: Importance of early management

IntroductionAnkylosing spondylitis (AS) affects 0.5% of the population. Alteration of the biomechanical properties of the spine related to AS explains the high prevalence of traumatic vertebral fractures and risk of instability. At admission, 65% of patients present neurological signs. There are no reported studies regarding secondary neurological deterioration. The aim of this study was to evaluate the rate of secondary neurological deterioration before surgical treatment of spine fracture in a context of AS.MethodsThis retrospective cases series consisted of patients admitted for traumatic cervical spine fractures or luxation in a context of AS between June 2007 and December 2012. Clinical status was evaluated using Frankel classification at time of trauma, at admission to the neurosurgery ward, as well as before and after surgery. Delay between trauma and admission, and between admission and surgery was recorded. Causes of morbidity, mortality and surgical management were discussed.ResultsDuring the study period, seven patients were admitted for traumatic cervical spine fracture or luxation. All patients were autonomous before trauma. Between trauma and transfer to neurosurgery ward, the status of four patients worsened. Mean delay between trauma and admission was 12.9 days (range 1 to 60 days). Between admission to neurosurgery ward and surgical treatment, two more patients worsened and only two patients remained autonomous. Mean delay between admission and surgery was 15.7 h (range 2 to 24 h). Neurological deterioration was due to both deterioration during transfer despite immobilization with a rigid cervical collar and failure of X-ray to reveal any fractures, in two and three cases respectively. After surgery, clinical status remained unchanged in two patients, four patients improved, and one patient worsened. Two patients died from respiratory failure a few days after surgery due to neurological deterioration. Five patients had a delayed diagnosis (> 24 h).ConclusionCervical spine fracture in AS is a serious condition with high instability. Our series emphasizes the necessity of early surgical treatment because of risk of secondary neurological deterioration in cases of delayed treatment. CT scan must be the gold standard for exploration of these patients.     

Double level Chance-type fractures of spine in ankylosing spondylitis

Chance fractures are usually associated with seat belt injuries. Mechanism is always related to flexion-distraction at vertebral level. Double level Chance-type fractures have rarely been reported in published literature. We presented such a fracture at D10 and L3 level in a 38-year-old patient with ankylosing spondylitis. Management was done with posterior decompression and short segment fixation separately.     

Corrective surgery for deformity of the upper cervical spine due to ankylosing spondylitis

Rotational and flexion deformity of C1-C2 due to ankylosing spondylitis is rare. We did surgical correction in one such case by lateral release, resection of the posterior arch of C1 and mobilization of the vertebral arteries, wedge osteotomy of the lateral masses of C1 and internal fixation under general anesthesia. There were no vascular and neurological complications during the surgery. After operation the atlantoaxial rotational deformity was corrected and the normal cervical lordosis was restored. At 1 year followup his visual field and feeding became normal and internal fixation was stable.     

Bilateral guided cervical block for Zenker diverticulum excision in a patient with ankylosing spondylitis

Patients with severe ankylosing spondylitis (AS) have difficulties in tracheal intubation. An 87-year-old man with severe AS was scheduled for Zenker diverticulum (ZD) excision. It was decided to proceed with combined bilateral cervical plexus blockade using a nerve stimulator. The surgery lasted about 3 h, with stable hemodynamics, ECG, and oxygen saturation. The use of a nerve stimulator-guided cervical block minimizes the risk of severe respiratory and/or airway compromise secondary to phrenic nerve or recurrent laryngeal nerve palsy, because it can elicit diaphragmatic muscle response, which helps to avoid the administration of local anesthetic directly to the area of the phrenic nerve, and guides correct needle placement. In conclusion, the nerve stimulatorguided bilateral cervical block in our ZD patient with AS was shown to be a safe and successful alternative anesthetic option.     

Spinal instability in ankylosing spondylitis

Background:

Unstable spinal lesions in patients with ankylosing spondylitis are common and have a high incidence of associated neurological deficit. The evolution and presentation of these lesions is unclear and the management strategies can be confusing. We present retrospective analysis of the cases of ankylosing spondylitis developing spinal instability either due to spondylodiscitis or fractures for mechanisms of injury, presentations, management strategies and outcome.

Materials and Methods:

In a retrospective analysis of 16 cases of ankylosing spondylitis, treated surgically for unstable spinal lesions over a period of 12 years (1995-2007); 87.5% (n=14) patients had low energy (no obvious/trivial) trauma while 12.5% (n=2) patients sustained high energy trauma. The most common presentation was pain associated with neurological deficit. The surgical indications included neurological deficit, chronic pain due to instability and progressive deformity. All patients were treated surgically with anterior surgery in 18.8% (n=3) patients, posterior in 56.2% (n=9) patients and combined approach in 25% (n=4) patients. Instrumented fusion was carried out in 87.5% (n=14) patients. Average surgical duration was 3.84 (Range 2-7.5) hours, blood loss 765.6 (± 472.5) ml and follow-up 54.5 (Range 18-54) months. The patients were evaluated for pain score, Frankel neurological grading, deformity progression and radiological fusion. One patient died of medical complications a week following surgery.

Results:

Intra-operative adverse events like dural tears and inadequate deformity correction occurred in 18.7% (n=3) patients (Cases 6, 7 and 8) which could be managed conservatively. There was a significant improvement in the Visual analogue score for pain from a pre-surgical median of 8 to post-surgical median of 2 (P=0.001), while the neurological status improved in 90% (n=9) patients among those with preoperative neurological deficit who could be followed-up (n =10). Frankel grading improved from C to E in 31.25% (n=5) patients, D to E in 12.5% (n=2) and B to D in 12.5% (n=2), while it remained unchanged in the remaining - E in 31.25% (n=5), B in 6.25% (n=1) and D in 6.25% (n=1). Fusion occurred in 11 (68.7%) patients, while 12.5% (n=2) had pseudoarthrosis and 12.5% (n=2) patients had evidence of inadequate fusion. 68.7% (n=11) patients regained their pre-injury functional status, with no spine related complaints and 25% (n=4) patients had complaints like chronic back pain and deformity progression. In one patient (6.2%) who died of medical complications a week following surgery, the neurological function remained unchanged (Frankel grade D). Persistent back pain attributed to inadequate fusion/ pseudoarthrosis could be managed conservatively in 12.5% (n=2) patients. Progression of deformity and pain secondary to pseudoarthrosis, requiring revision surgery was noted in one patient (6.2%). One patient (6.2%) had no neurological recovery following the surgery and continued to have nonfunctional neurological status.

Conclusion:

In ankylosing spondylitis, the diagnosis of unstable spinal lesions needs high index of suspicion and extensive radiological evaluation Surgery is indicated if neurological deficit, two/three column injury, significant pain and progressive deformity are present. Long segment instrumentation and fusion is ideal.     

强直性脊柱炎颈椎隐匿不全骨折非手术治疗例报告

隐匿骨折（OF）指常规X线检查不能发现或疑似但不能明确诊断,需其他特殊检查才能发现的骨折^[1]。强直性脊柱炎（AS）患者脊椎强直后力学特性发生变化,轻微暴力就可能导致其骨折^[2-3]。本院曾收治2例AS并颈椎隐匿不全骨折患者,确诊后给予非手术治疗,未进展到完全骨折。现将诊疗过程报告如下。