Abstract
Introduction
Patients with ankylosing spondylitis have a significantly increased risk of spinal injury when compared with the general population. Due to the pathogenesis of this condition, they are prone to spinal fractures even with low-energy mechanisms of injury. Since being established, the National Spinal Unit has admitted a significant number of these patients with a wide range of spinal injuries for surgical management. In this study, we reviewed fractures in patients with ankylosing spondylitis to better define the mechanism of injury, associated neurological deficit, predisposing factors, management strategies, and clinical outcomes.
Material and Methods
Between January 2005 and September 2015, 28 patients with fractures were treated in the Unit. Imaging evaluation was obtained in all patients by using plain radiography, CT scan, and MRI. The ASIA Impairment Scale was used to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. A retrospective chart review was performed to determine patient factors, mechanism of injury, pre-operative status, management, and post-operative course.
Results
Of 28 patients reviewed, 21 cervical fractures and 8 thoracic fractures were identified. 14 cases were caused by minor trauma. Post-traumatic neurological deficits demonstrated by ASIA assessment in 15 patients with neurological improvement seen in 8 of these cases.
Conclusion
Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.