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Chen W, Yang Y, Pan W, Lei X, Hong Z, Luo H. Treatment of lower cervical spine fracture with ankylosing spondylitis by simple long anterior cervical plate: a retrospective study of 17 cases. Front Neurol 2024; 15:1300597. [PMID: 39015319 PMCID: PMC11249536 DOI: 10.3389/fneur.2024.1300597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Objective Ankylosing spondylitis (AS), an autoimmune disease, often leads to lower cervical spine fractures, with the potential for severe spinal nerve damage even from low-energy injuries. The optimal treatment approach remains debated. Methods A retrospective study involved 17 AS patients with lower cervical spine fractures who received anterior cervical fixation. Most presented cervicothoracic or thoracolumbar kyphosis, with 11 exhibiting neurological deficits. Patient characteristics, clinical data, visual analog scale (VAS), complications, and nerve recovery were analyzed. Results No postoperative neurological deterioration occurred. All cases experienced complete fusion of fractures during the follow-up period. Preoperative VAS significantly decreased at 3 days and 3 months post-surgery. Of the 11 patients with preoperative neurological deficits, approximately 54.5% showed improvement post-surgery. No complications were reported, such as esophageal fistula, wound infection, or fixation failure. Conclusion Anterior internal fixation is a possible treatment for AS-related lower cervical fractures. This approach ensures satisfactory spinal stability and neurological recovery with proper cranial traction and external fixation post-surgery. Our findings demonstrate that this surgical method is safe and effective.
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Affiliation(s)
| | | | | | | | - Zhenghua Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated with Wenzhou Medical University, Taizhou, Zhejiang Province, China
| | - Hua Luo
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated with Wenzhou Medical University, Taizhou, Zhejiang Province, China
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Schaefer RO, Rutsch N, Schnake KJ, Aly MM, Camino-Willhuber G, Holas M, Spiegl U, Muijs S, Albers CE, Bigdon SF. Rigid spine injuries - A comprehensive review on diagnostic and therapeutic challenges. BRAIN & SPINE 2024; 4:102811. [PMID: 38681176 PMCID: PMC11052905 DOI: 10.1016/j.bas.2024.102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Injuries to the rigid spine have a distinguished position in the broad spectrum of spinal injuries due to altered biomechanical properties. The rigid spine is more prone to fractures. Two ossification bone disorders that are of particular interest are Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH). DISH is a non-inflammatory condition that leads to an anterolateral ossification of the spine. AS on the other hand is a chronic inflammatory disease that leads to cortical bone erosions and spinal ossifications. Both diseases gradually induce stiffening of the spine. The prevalence of DISH is age-related and is therefore higher in the older population. Although the prevalence of AS is not age-related the occurrence of spinal ossification is higher with increasing age. This association with age and the aging demographics in industrialized nations illustrate the need for medical professionals to be adequately informed and prepared. The aim of this narrating review is to give an overview on the diagnostic and therapeutic measures of the ankylosed spine. Because of highly unstable fracture configurations, injuries to the rigid spine are highly susceptible to neurological deficits. Diagnosing a fracture of the ankylosed spine on plain radiographs can be challenging. Moreover, since 8% of patients with ankylosing spine disorders (ASD) have multiple non-contagious fractures, a CT scan of the entire spine is highly recommended as the primary diagnostic tool. There are no consensus-based guidelines for the treatment of spinal fractures in ASD. The presence of neurological deficit or unstable fractures are absolute indications for surgical intervention. If conservative therapy is chosen, patients should be monitored closely to ensure that secondary neurologic deterioration does not occur. For the fractures that have to be treated surgically, stabilization of at least three segments above and below the fracture zone is recommended. These fractures mostly are treated via the posterior approach. Patients with AS or DISH share a significant risk for complications after a traumatic spine injury. The most frequent complications for patients with thoracolumbar burst fractures are respiratory failure, pseudoarthrosis, pneumonia, and implant failure.
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Affiliation(s)
| | - Niklas Rutsch
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Mohamed M. Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Martin Holas
- Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Ulrich Spiegl
- Klinik für Unfallchirurgie und Orthopädie, Klinik München Harlaching, Sanatoriumspl. 2, 81545, München, Germany
| | - Sander Muijs
- University Medical Centers, Utrecht, the Netherlands
| | - Christoph E. Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Sebastian F. Bigdon
- Department of Orthopaedic Surgery, Sonnenhof Spital, University Bern, 3006, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
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Kang KH, Seok SY, Cho JH. Concurrently Occurring Spinal Cord Cross-Section and Aortic Injury After a Chalk-Stick Fracture and Dislocation in Patient with Ankylosing Spondylitis: Clinical Image. World Neurosurg 2024; 184:149-151. [PMID: 38278209 DOI: 10.1016/j.wneu.2024.01.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
A 74-year-old woman with ankylosing spondylitis presented with back pain and complete paraplegia after a fall. A radiologic finding of a bamboo spine, a characteristic feature of ankylosing spondylitis, was observed on computed tomography, along with a fracture-dislocation involving T10 and T11 (chalk-stick fracture) and compression of the descending thoracic aorta due to the caudal bony column. The patient underwent an open reduction and T8-L3 posterior fusion in the operating room. A complete cross-section of the spinal cord was observed during surgery. Post operation, a decrease in blood pressure led to a thoracotomy and thoracic endovascular aortic repair due to a crack in the descending aorta wall. Thoracolumbar fracture-dislocations, particularly in patients with ankylosing spondylitis, are characterized by instability and can be further complicated by concurrent vascular and spinal cord injuries. It is crucial therefore to recognize the potential for vascular and spinal cord injuries early on in such cases.
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Affiliation(s)
- Kyun Ho Kang
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Yun Seok
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Jae Hwan Cho
- Departments of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dinis SP, Pinto AS, Santos FC, Augusto D, Fonseca Ferreira J, Vaz C, Madeira N. Delayed diagnosis of vertebral fracture in long-standing ankylosing spondylitis. Rheumatol Adv Pract 2024; 8:rkae025. [PMID: 38505767 PMCID: PMC10948276 DOI: 10.1093/rap/rkae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Sara Paiva Dinis
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Ana Sofia Pinto
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | | | - Duarte Augusto
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Joana Fonseca Ferreira
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
- Faculdade de Ciências da Saúde daUniversidade da Beira Interior, Covilhã, Portugal
| | - Cláudia Vaz
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
- Faculdade de Ciências da Saúde daUniversidade da Beira Interior, Covilhã, Portugal
| | - Nathalie Madeira
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
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Elsamadicy AA, Sayeed S, Sadeghzadeh S, Reeves BC, Sherman JJZ, Craft S, Serrato P, Larry Lo SF, Sciubba DM. Implications of Frailty on Postoperative Health Care Resource Utilization in Ankylosing Spondylitis Patients Undergoing Spine Surgery for Spinal Fractures. World Neurosurg 2024; 182:e16-e28. [PMID: 37925147 DOI: 10.1016/j.wneu.2023.10.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE The rise of spinal surgery for ankylosing spondylitis (AS) necessitates balancing health care costs with quality patient care. Frailty has been independently associated with adverse outcomes and increased costs. This study investigates whether frailty is an independent predictor of poor outcomes after elective surgery for AS. METHODS Using the National Inpatient Sample (NIS) database, a retrospective study was conducted on adult patients with AS who underwent posterior spinal fusion for fracture between 2016 and 2019. Each patient was assigned a modified frailty index (mFI) score and categorized as prefrail (mFI = 0 or 1), moderately frail (mFI = 2), and highly frail (mFI≥3). Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay, non-routine discharge (NRD), and exorbitant admission costs. RESULTS Of the 1910 patients, 35.3% were prefrail, 31.2% moderately frail, and 33.5% highly frail. Age was significantly different across groups (P < 0.001), and frailty was associated with increased comorbidities (P < 0.001). Mean length of stay (P = 0.007), NRD rate (P < 0.001), and mean cost of admission (P = 0.002) all significantly increased with increasing frailty. However, frailty was not an independent predictor of extended hospital stay, NRD, or higher costs on multivariate analysis. Instead, predictors included multiple adverse events, number of comorbidities, and race. CONCLUSIONS While frailty in patients with AS is associated with older age, greater comorbidities, and increased adverse events, it was not an independent predictor of extended hospital stay, NRD, or higher hospital costs. Further research is required to understand the full impact of frailty on surgical outcomes and develop effective interventions.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina Sadeghzadeh
- Department of Neurosurgery, Stanford School of Medicine, Stanford, California, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul Serrato
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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Li CM, Zhao SJ, Xu JZ, Li Q, Quan RF, Deng XM. Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures. Medicine (Baltimore) 2023; 102:e36807. [PMID: 38206734 PMCID: PMC10754571 DOI: 10.1097/md.0000000000036807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
Here we assessed the accuracy of O-arm navigation assisted by Wiltse approach to improve based pedicle screw insertion in ankylosing spondylitis combined with thoracolumbar fractures. We then compared it with the freehand pedicle screw insertion technique. The study sample included 32 patients with ankylosing spondylitis combined with thoracolumbar fractures. Pedicle screw reduction and internal fixation was performed under an O-arm navigation system assisted by a Wiltse approach-combined osteotomy ("navigation group," n = 17) and posterior pedicle screw reduction and internal fixation was performed using freehand technique combined osteotomy ("freehand group," n = 15). We then compared the operation time and bleeding volume between the 2 groups. The visual analog scale (VAS) and Oswestry disability index (ODI) were then used to evaluate the clinical efficacy and the kyphosis Cobb angle was used to evaluate the radiological efficacy before operation, 3 days after operation and after the last follow-up. All complications were noted when detected. Finally, classification of screw positions as proposed by Neo et al was used to evaluate the relationship of the position between the screw, the bone cortex, and the incidence of screw penetration. All patients were followed up for 18 to 36 months (i.e., 24.2 ± 3.5 months). The operation time and intraoperative bleeding volume of the navigation group were significantly shorter (lower) than those of the freehand group (P < .05). In addition, Both groups showed significantly decreased VAS, ODI, and Cobb angle 3 days after the operation and at the last follow-up when compared to values recorded pre-operation. However, we found no significant difference in VAS, ODI, and Cobb angle between the 2 groups (P > .05). We identified no complications (e.g., infection, VTE/PE, or nerve injury). Moreover, the pedicle screw placement position of the navigation group was better than that of the freehand group (P < .05), and the screw cortical penetration rate was lower than the freehand group (P < .05). During the process of posterior pedicle screw placement, O-arm navigation assisted by the Wiltse approach can significantly reduce operation time, minimize the amount of bleeding volume, and enhance the accuracy of pedicle screw implantation.
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Affiliation(s)
- Chang-Ming Li
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, XiaoShan District, Hangzhou, Zhejiang Province, China
| | - Shi-Jie Zhao
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, XiaoShan District, Hangzhou, Zhejiang Province, China
| | - Jian-Zhu Xu
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, XiaoShan District, Hangzhou, Zhejiang Province, China
| | - Qiang Li
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, XiaoShan District, Hangzhou, Zhejiang Province, China
| | - Ren-Fu Quan
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, XiaoShan District, Hangzhou, Zhejiang Province, China
| | - Xiao-Mei Deng
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, XiaoShan District, Hangzhou, Zhejiang Province, China
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Vanhoenacker FM, Vanhoenacker C, Lalam R. Complications of the Rigid Spine. Semin Musculoskelet Radiol 2023; 27:491-498. [PMID: 37816357 DOI: 10.1055/s-0043-1770136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
We present a short overview of the most common causes and imaging findings of a rigid spine including long-standing spondylarthritis, diffuse idiopathic skeletal hyperostosis, and the less common ossification of the posterior longitudinal ligament. The article also focuses on the pathogenesis and imaging findings of acute complications of the rigid spine due to fractures. These fractures may occur even after minor trauma and are difficult to detect on initial radiographs, resulting in a delayed diagnosis. They are often unstable with a high risk of severe neurologic complications, leading to high morbidity and mortality both in the initial phase and in the months following the fracture. Because the negative predictive value of conventional radiography is low, every patient with a rigid spine with newly appearing pain should be referred for subsequent cross-sectional imaging.
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Affiliation(s)
- Filip M Vanhoenacker
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Antwerp and Ghent, Belgium
- Faculty of Medicine, KU Leuven, Belgium
| | | | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, United Kingdom
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de Los Cobos D, Nwadike BA, Padhye K. Thoracic Spine Fracture After Cardiopulmonary Resuscitation in a Patient with Ankylosing Spondylitis: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00016. [PMID: 37478319 DOI: 10.2106/jbjs.cc.23.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
CASE A 32-year-old man with a history of ankylosing spondylitis presented to the emergency department because of sepsis secondary to Fournier's gangrene and subsequently went into cardiac arrest requiring cardiopulmonary resuscitation (CPR). On the twelfth hospital day, a fracture through the T5-T6 intervertebral disk space was incidentally found on a chest, abdominal, and pelvic Computed Tomography (CT) scan. The rounds of CPR were the only traumatic event that the patient underwent before the discovery of the spine fracture. CONCLUSION A low threshold for advanced imaging should be held to rule out occult spine fractures in patients with ankylosed spines after receiving CPR.
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9
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Tang Z, Chen T, Tan J, Zhang H. Surgical Outcomes and Prognostic Factors for Cervical Spine Fractures in Patients with Ankylosing Spondylitis. World Neurosurg 2022; 166:e278-e284. [PMID: 35809842 DOI: 10.1016/j.wneu.2022.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) often results in progressive spinal stiffness, making patients prone to spinal fractures. Cervical spine fractures in AS mostly occur in the lower segment and cause progressive neurological deficits. However, the optimal approach to treating this patient population is still controversial, and it is unclear what factors have an impact on prognosis. Thus, this study aimed to investigate the choice of surgical approach and prognostic factors in AS patients with cervical spine fractures. METHODS A total of 22 AS patients with cervical fracture who were treated in our institution were reviewed from 2015 to 2020. We analyzed demographic data, perioperative complications, postoperative results, and radiographic results. The Japanese Orthopaedic Association (JOA) score was used to assess preoperative and postoperative spinal cord function, and the improvement rate was calculated. RESULTS Twenty-two patients were enrolled, including 6 patients in the anterior approach group, 11 in the posterior approach group, and 5 in the combined approach group. The operative time and intraoperative blood loss in the anterior approach group were significantly less than those in the posterior approach group and combined approach group (P = 0.00). Patients who underwent surgery within 48 hours of injury had a lower JOA score than patients who underwent surgery later (P = 0.01). Basic AS treatment before injury significantly improved JOA scores after surgery (P = 0.01). CONCLUSIONS All approaches can provide good clinical results, and thus, the surgical approach should be individualized. It remains unclear whether the operation should be performed as soon as possible. Basic AS treatment is an independent factor that affects the prognosis of cervical spine fracture patients with AS.
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Affiliation(s)
- Zhongxin Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Tailong Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jun Tan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Huafeng Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Huang J, Bai H, Tan Q, Hao D, Wu A, Wang Q, Wang B, Wang L, Liu H, Chen X, Jiang Z, Ma X, Liu X, Liu P, Cai W, Lu M, Mao N, Wang Y, Fu S, Zhao S, Zang X, Xie Y, Yu H, Song R, Sun J, Xiang L, Liu X, Li S, Liao B, Wu Z. Instantaneous death risk, conditional survival and optimal surgery timing in cervical fracture patients with ankylosing spondylitis: A national multicentre retrospective study. Front Immunol 2022; 13:971947. [PMID: 36189242 PMCID: PMC9521542 DOI: 10.3389/fimmu.2022.971947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe mortality rate in patients with ankylosing spondylitis (AS) and cervical fracture is relatively high.ObjectivesThis study aimed to investigate the instantaneous death risk and conditional survival (CS) in patients with AS and cervical fracture. We also studied the relationship between surgical timing and the incidence of complications.MethodsThis national multicentre retrospective study included 459 patients with AS and cervical fractures between 2003 and 2019. The hazard function was used to determine the risk of instantaneous death. The five-year CS was calculated to show the dynamic changes in prognosis.ResultsThe instantaneous death risk was relatively high in the first 6 months and gradually decreased over time in patients with AS and cervical fracture. For patients who did not undergo surgery, the instantaneous risk of death was relatively high in the first 15 months and gradually decreased over time. For patients with American Spinal Injury Association impairment scale (ASIA) A and B, the 5-year CS was 55.3% at baseline, and improved steadily to 88.4% at 2 years. Odds ratios (ORs) for pneumonia, electrolyte disturbance, respiratory insufficiency, and phlebothrombosis decreased as the surgery timing increased.ConclusionDeaths occurred mainly in the first 6 months after injury and gradually decreased over time. Our study highlights the need for continued surveillance and care in patients with AS with cervical fractures and provides useful survival estimates for both surgeons and patients. We also observed that early surgery can significantly increase functional recovery, and decrease the incidence of complications and rehospitalisation.
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Affiliation(s)
- Jinfeng Huang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Hao Bai
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Quanchang Tan
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Aimin Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qingde Wang
- Department of Spine Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, China
| | - Bing Wang
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Linfeng Wang
- Department of Orthopedics, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhengsong Jiang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoming Ma
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Ningxia, China
| | - Xinyu Liu
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Peng Liu
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Weihua Cai
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Lu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ningfang Mao
- Department of Spinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yong Wang
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suochao Fu
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou, China
| | - Shuai Zhao
- Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaofang Zang
- Department of Orthopaedics, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Youzhuan Xie
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haiyang Yu
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang, China
| | - Ruixian Song
- Department of Orthopedics, PLA 960th Hospital, Jinan City, China
| | - Jiangbo Sun
- Department of Orthopaedics, Shaoyang Zhenggu Hospital, Shaoyang, China
| | - Liangbi Xiang
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiang Liu
- Department of Orthopaedics, Hebei Aidebao Hospital, Langfang, China
| | - Songkai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, China
| | - Bo Liao
- Department of Orthopaedics Tangdu Hospital, The Air Force Medical University, Xi’an, China
- *Correspondence: Bo Liao, ; Zixiang Wu,
| | - Zixiang Wu
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, China
- *Correspondence: Bo Liao, ; Zixiang Wu,
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11
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Tu PH, Liu ZH, Yeap MC, Liu YT, Li YC, Huang YC, Lin TM, Chen CC. Spinal cord injury and spinal fracture in patients with ankylosing spondylitis. BMC Emerg Med 2022; 22:73. [PMID: 35501709 PMCID: PMC9063196 DOI: 10.1186/s12873-022-00635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Spinal cord injury (SCI) and spinal fracture are major complications in patients with ankylosing spondylitis (AS) who sustain spinal trauma. The purpose of this study was to investigate the incidence, predictors, and sequelae of spinal trauma in patients with AS. Methods This retrospective study included patients with AS who were admitted for spinal trauma between January 1, 2006, and June 30, 2016. The study compared clinical outcomes of patients between group 1: SCI alone, group 2: spinal fracture alone (no SCI), and group 3: both SCI and spinal fracture. Results Of the 6285 patients with AS admitted during the retrospective study period, only 105 suffered from spinal trauma and were enrolled in the study. Case number in group 1, 2, and 3 was 11(10.48%), 45(42.85%), and 49(46.67%), respectively. Among the patients with spinal fractures, 52.1% had SCI. Bamboo spine was significantly more prevalent in the fracture group than in the nonfracture group (78.7% vs. 36.4%; P = 0.006). Patients with SCI had more instances of subluxation or dislocation (48.3% vs. 8.9%; P < 0.001) and more cases of spinal epidural hematoma (SEH; 21.7% vs. 2.2%; P = 0.003) than patients without SCI. The rate of delayed diagnosis for spinal fracture was 31.4%, with one-third of patients developing delayed SCI. Among the patients with incomplete SCI, 58.3% achieved neurological improvement after treatment (P = 0.004). Conclusions Patients with AS and bamboo spine at radiograph had a higher rate of spinal fracture, which may be an important factor in SCI in patients with AS. Spinal fractures involving the C3–C7 region, subluxation or dislocation, severe spinal fracture, and SEH were found to be predictive of SCI, and SCI in patients with AS resulted in higher mortality and complication rates.
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Affiliation(s)
- Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Ying-Ching Li
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Tzu-Min Lin
- Department of Internal Medicine, Division of Rheumatology, Immunology and Allergy, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Internal Medicine, Division of Allergy, Immunology and Rheumatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
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Dorado Fernández E, Sebastián Sebastián C, Aso Vizán A, Aso Escario J. Spinal fracture secondary to resuscitation procedures. Clinical and medicolegal issues. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:311-313. [PMID: 35643758 DOI: 10.1016/j.redare.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/19/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Dorado Fernández
- Instituto de Medicina Legal, Madrid, Spain, Sección de Antropología y Odontología, Madrid, Spain
| | | | - A Aso Vizán
- Servicio de Traumatología y Cirugía Ortopédica, Hospital General de la Defensa. Zaragoza, Spain
| | - J Aso Escario
- Servicio de Neurocirugía, Hospital MAZ. Zaragoza, Spain.
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Wang Y, Zhou Z, Chen L, He X, Li H, Huang Y, Pu Y. Efficacy of Duhuo Jisheng Decoction in Treating Ankylosing Spondylitis: Clinical Evidence and Potential Mechanisms. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:3305773. [PMID: 35419071 PMCID: PMC9001112 DOI: 10.1155/2022/3305773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
Background Duhuo Jisheng Decoction (DHJSD) is an ancient compound widely used in the treatment of ankylosing spondylitis (AS). However, its efficacy is controversial, and its mechanism of action is not clear enough. Using meta-analysis and network pharmacology, our study evaluated the clinical efficacy of DHJSD in the treatment of AS and explored its mechanisms of action. Methods We searched medical databases, including Embase, PubMed, the China National Knowledge Infrastructure databases, Wanfang, and the Chinese Scientific Journal Database, to identify studies that met the inclusion criteria. RevMan 5.3 software was used for the meta-analysis. The compounds and the potential protein targets of DHJSD were obtained from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database and analysis platform. AS was treated as a search query in the NCBI, PharmGKB, TTD, DrugBank, and OMIM databases to obtain disease-related genes. The overlapping targets of DHJSD and AS were identified, and then Gene Ontology functional enrichment and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed. Cytoscape was employed to construct a drug-compound-target network and a protein-protein interaction (PPI) network. CytoHubba was utilized to select the hub genes. Results A total of 10 studies involving 860 participants were included in the meta-analysis. Compared with the control, DHJSD treatment significantly improved clinical symptoms; reduced the erythrocyte sedimentation rate (ESR), the C-reactive protein (CPR), and interleukin 6 (IL-6) levels; increased the degree of motion of the chest; reduced the visual analog scale (VAS) pain score; reduced Schober's test values; reduced the finger-to-floor distance; reduced the duration of morning stiffness. However, the differences were not statistically significant in the Bath Ankylosing Spondylitis Functional Index scores, the Bath Ankylosing Spondylitis Disease Activity Index scores, the bone Gla-containing protein (BGP) levels, or the bone alkaline phosphatase (BALP) levels. In terms of adverse events, DHJSD treatment of AS reduced the incidence of gastrointestinal events, the incidence of skin events, and the incidence of abnormal liver function; however, there was no statistically significant reduction in the incidence of adverse renal function events. Subgroup analysis showed that in the treatment of AS, the clinical effect of DHJSD for AS was better than that of the controls for both treatment durations, ≤2 months and >2 months. A total of 178 active compounds and 47 related potential targets were identified for DHJSD in the treatment of AS, including four hub genes (CXCL8, PTGS2, VEGFA, and STAT3). The core active ingredients of DHJSD in the treatment of AS were mainly quercetin, kaempferol, licochalcone A, and isorhamnetin. DHJSD treatment of AS-related pathways mainly involved the IL-17 signaling pathway, the TNF signaling pathway, and the rheumatoid arthritis signaling pathway. Conclusion The above results suggest that DHJSD acts on AS through multiple targets, components, and pathways with significant clinical efficacy. Future studies may further explore the active components of DHJSD.
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Affiliation(s)
- Yi Wang
- Department of Orthopedic, Chongqing Jiangbei hospital of Traditional Chinese Medicine, Chongqing 400020, China
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, College of Traditional Chinese Medicine, Chongqing 400016, China
| | - Zhihua Zhou
- Department of Orthopedic, Chongqing Jiangbei hospital of Traditional Chinese Medicine, Chongqing 400020, China
| | - Li Chen
- Department of Orthopedic, Chongqing Jiangbei hospital of Traditional Chinese Medicine, Chongqing 400020, China
| | - Xiangwei He
- Department of Orthopedic, Chongqing Jiangbei hospital of Traditional Chinese Medicine, Chongqing 400020, China
| | - Hui Li
- Department of Orthopedic, Chongqing Jiangbei hospital of Traditional Chinese Medicine, Chongqing 400020, China
| | - Yingru Huang
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, College of Traditional Chinese Medicine, Chongqing 400016, China
| | - Yu Pu
- Department of Orthopedic, Chongqing Jiangbei hospital of Traditional Chinese Medicine, Chongqing 400020, China
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Urbański W, Zaluski R. Surgical Treatment of Spinal Fracture in a Patient With Ankylosing Spondylitis: An Opportunity To Correct Spinal Deformity Simultaneously With Fracture Fixation? Cureus 2022; 14:e21936. [PMID: 35273877 PMCID: PMC8900830 DOI: 10.7759/cureus.21936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/24/2022] Open
Abstract
The objective of this case report is to describe the substantial sagittal correction of spinal hyperkyphosis alongside fracture fixation. In advanced ankylosing spondylitis (AS), the spine is usually fused, hyperkyphotic, and due to deformity, as well as improper bone remodeling, predisposed to fractures. These fractures, mostly unstable, require surgical treatment. The authors present fracture management with concomitant deformity correction at the fracture site and pedicle subtraction osteotomy (PSO) below the fracture, showing the benefits of performing the procedures with the patient in a sitting position. A 58-year-old male with AS was diagnosed with a fracture of C6 and referred to the department of neurosurgery, Wroclaw University Hospital. For the last week, he had complained of worsening neck pain and exacerbation of spinal kyphosis, with no neurological deficits. The patient had a fully fused spine, significant hyperkyphosis prior to the injury, and a fracture with an additionally exacerbated deformity. The patient was offered operative treatment - spinal fusion and fracture reduction with hyperkyphosis correction. The procedure consisted of 1) partial, mostly closed correction at the fracture site, 2) PSO of C7 and C2-T3 pedicular fixation and fusion while sitting in the posterior approach. To enable closed reduction at the fracture site and avoid difficulties with positioning a prone patient with very severe hyperkyphosis and an unstable spine, the authors performed surgical procedures with the patient in a sitting position. The authors obtained significant correction during the procedure by 740, from 53.40 of kyphosis to 24.30 of lordosis measured between C2 and T1. The patient had several complications (transient weakness of the upper limb, pleural effusion, and delayed wound healing); however, all resolved and the patient was discharged within two weeks post the operation. In patients with spinal hyperkyphosis with AS who sustain spinal fractures requiring operative treatment, it is worth considering simultaneous correction of the spinal deformity during surgical management of the fracture.
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Hanna G, Uddin SA, Trontis A, Ross L, Drazin D, Kim TT, Johnson JP. Epidural hematoma in patients with ankylosing spondylitis requiring surgical stabilization: a single-institution retrospective review with literature analysis. Neurosurg Focus 2021; 51:E5. [PMID: 34598124 DOI: 10.3171/2021.7.focus21334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen-B27. There appears to be an increased frequency of associated epidural hematomas in spine fractures in patients with AS. The objective was to review the incidence within the literature and a single-institution experience of the occurrence of epidural hematoma in the context of patients with AS requiring spine surgery. METHODS Deep 6 AI software was used to search the entire database of patients at a single level I trauma center (since the advent of the institution's modern electronic health record system) to look at all patients with AS who underwent spinal surgery and who had a diagnosis of epidural hematoma. Additionally, a systemic literature review was performed of all papers evaluating the incidence of epidural hematoma in patients with spine fractures. RESULTS A single-institution, retrospective review of records from 2009 to 2020 yielded a total of 164 patients with AS who underwent spine surgery. Of those patients, 17 (10.4%) had epidural hematomas on imaging, with the majority requiring surgical decompression. These spine fractures occurred close to the cervicothoracic or thoracolumbar junction. The patients ranged in age from 51 to 88 years, and there were 14 males and 3 females in the cohort. Eight patients were administered an antiplatelet and/or anticoagulant agent, and the rest were not. All patients required surgical stabilization, with 64.7% of patients also requiring decompressive laminectomies for evacuation of the hematoma and spinal cord decompression. Only 1 death was reported in the series. There was a tendency toward neurological improvement after surgical intervention. CONCLUSIONS AS has been a well-described pathologic process that leads to an increased risk of three-column injury in spine fracture, with an increased incidence of symptomatic epidural hematoma compared with patients without AS. Early recognition of this entity is important to ensure that appropriate surgical management includes addressing compression of the neural elements in addition to surgical stabilization.
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Affiliation(s)
- George Hanna
- 1Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles
| | - Syed-Abdullah Uddin
- 1Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles.,3University of California, Riverside (UCR) School of Medicine, Riverside, California; and
| | - Andrew Trontis
- 2Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles; and
| | - Lindsey Ross
- 1Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles
| | - Doniel Drazin
- 4Pacific Northwest University of Health Sciences College of Medicine, Yakima, Washington
| | - Terrence T Kim
- 2Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles; and
| | - J Patrick Johnson
- 1Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles
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16
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Tong Z, Xiao B, Yan K, Xing Y, Zhang Y. Biomechanical Evaluation of the Transcortical and Transpedicular Trajectories for Pedicle Screw Insertion in Thoracolumbar Fracture Fixation for Ankylosing Spondylitis. Front Surg 2021; 8:706597. [PMID: 34568415 PMCID: PMC8456994 DOI: 10.3389/fsurg.2021.706597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Ankylosing spondylitis (AS) is a chronic disorder characterized by an imbalance between bone formation and resorption. Spinal fractures often occur after minor trauma in patients with AS. For thoracolumbar fractures, transpedicular screw (TPS) fixation through the posterior approach has been suggested. The cortical bone trajectory (CBT) technique has also been used to prevent screw pull-out in patients with poor bone quality. The aim of current study was to assess the biomechanical characteristics of the TPS and CBT technique in thoracolumbar AS fracture fixation by finite element analysis. Methods: The three-dimensional finite element models of the AS spine were created. The CBT and TPS methods of screw insertion were used in AS spinal fracture models. An intact AS spine model was considered the control. An axial force and torsion in rotation, flexion/extension and lateral flexion were applied in all models in CBT, TPS, and control groups. Results: The AS spine showed similar construct stiffness after posterior fixation by CBT and TPS techniques under axial, rotational, and flexion/extension loading conditions. The TPS technique showed better intact stability under all loading conditions. Similarly, the TPS technique provided superior fracture regional stability against axial and rotational loads than did the CBT technique. The maximum von Mises stresses were 1714.4 ± 129.8 MPa and 1208.7 ± 107.3 MPa (p < 0.001), which occurred in the CBT and TPS groups under compressive loading. Conclusions: The TPS technique provides better biomechanical strength under axial, rotational, flexion/extension, and lateral flexion loading than does the CBT technique. Compared with CBT, TPS is more effective in maintaining the stability of AS thoracolumbar fractures from a finite element analysis perspective.
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Affiliation(s)
- Zhizhong Tong
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Bin Xiao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Kai Yan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yonggang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yanbin Zhang
- Department of Education, Beijing Jishuitan Hospital, Beijing, China
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Yang SZ, Huang SS, Yi WB, Lv WW, Li L, Qi F. Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients. World J Clin Cases 2021; 9:6705-6716. [PMID: 34447817 PMCID: PMC8362533 DOI: 10.12998/wjcc.v9.i23.6705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/21/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with ankylosing spondylitis (AS) combined with severe cervical fusion deformity have difficult airways. Awake fiberoptic intubation is the standard treatment for such patients. Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists. Bronchial blockers (BBs) have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.
AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.
METHODS We studied 12 AS patients (11 men and one woman) with lung or esophageal cancer who underwent thoracotomy with a BB. Preoperative airway evaluation found that all patients had a difficult airway. All patients received an intramuscular injection of penehyclidine hydrochloride (0.01 mg/kg) before anesthesia. In the operating room, dexmedetomidine(0.5 μg/kg) was infused intravenously for 10 min, with 2% lidocaine for airway surface anesthesia, and a 3% ephedrine cotton swab was used to contract the nasal mucosa vessels. Before tracheal intubation, fentanyl (1 μg/kg) and midazolam (0.02 mg/kg) were administered intravenously. Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position. Intravenous anesthesia was administered immediately after successful intubation, and a BB was inserted laterally. The pre-intubation preparation time, intubation time, facial grimace score, airway responsiveness score during the fiberoptic introduction, time of end tracheal catheter entry into the nostril, and lung collapse and surgical field score were measured. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded while entering the operation room (T1), before intubation (T2), immediately after intubation (T3), 2 min after intubation (T4), and 10 min after intubation (T5). After surgery, all patients were followed for adverse reactions such as epistaxis, sore throat, hoarseness, and dysphagia.
RESULTS All patients had a history of AS (20.4 ± 9.6 years). They had a Willson's score of 5 or above, grade III or IV Mallampati tests, an inter-incisor distance of 2.9 ± 0.3 cm, and a thyromental (T-M) distance of 4.8 ± 0.7 cm. The average pre-intubation preparation time was 20.4 ± 3.4 min, intubation time was 2.6 ± 0.4 min, facial grimace score was 1.7 ± 0.7, airway responsiveness score was 1.1 ± 0.7, and pulmonary collapse and surgical exposure score was 1.2 ± 0.4. The SBP, DBP, and HR at T5 were significantly lower than those at T1-T4 (P < 0.05). While the values at T1 were not significantly different from those at T2-T4 (P > 0.05), they were significantly different from those at T5 (P < 0.05). Seven patients had minor epistaxis during endotracheal intubation, two were followed 24 h after surgery with a mild sore throat, and two had hoarseness without dysphagia.
CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia. Proper doses of penehyclidine hydrochloride, dexmedetomidine, fentanyl, and midazolam, combined with 2% lidocaine, administered prior to intubation, can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients. BBs are safe and effective for one-lung ventilation in such patients during thoracotomy.
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Affiliation(s)
- Shao-Zhong Yang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Shan-Shan Huang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Wen-Bo Yi
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Wei-Wei Lv
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Liang Li
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Feng Qi
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Liu B, Ji H, Zhang Z, Guo Y, Lv Y, Yang Z, Hou G, Zhou F, Tian Y. Surgical Treatment for Cervical Spine Fracture in Patients With Ankylosing Spondylitis: Single Posterior Approach or Combined Anterior-posterior Approach? Clin Spine Surg 2021; 34:E308-E314. [PMID: 33769977 DOI: 10.1097/bsd.0000000000001155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022]
Abstract
STUDY DESIGN A retrospective single-center study. OBJECTIVE We aimed to compare the clinical outcomes of cervical spine fracture accompanied with ankylosing spondylitis (ASCSF) treated by single posterior approach (PA) and combined anterior-posterior approach (CA) for patients who were followed up for >1 year. SUMMARY OF BACKGROUND DATA For ASCSF patients, surgical treatment has been widely accepted as a recommendable therapeutic option. But the optimal surgical approach is still under controversy, and few studies have focused on the comparison between PA and CA. MATERIALS AND METHODS From February 2007 to March 2019, 53 patients were enrolled and divided into the PA group (34 cases) and CA group (19 cases). Their general characteristics and clinical materials were recorded. From the aspects of reduction distance, bone fusion, neurological functional restoration, and postoperative complications, patients' surgical outcomes were evaluated qualitatively and quantitatively. RESULTS The reduction degree of dislocation (mean PA=2.05 mm, mean CA=2.36 mm, P=0.94) was close between the 2 groups. Besides, with a similar follow-up period (P=0.10), the rate of bone fusion (both 100%) and neurological functional restoration (PA=31.03%, CA=35.29%, P=0.77) were also without significant difference. The occurrence rate of postoperative complications tended to be higher in the CA group (31.58% vs. 23.53%) but with no significant difference (P=0.52). Nevertheless, the surgical duration time (mean=209.15 min) and blood loss (average=388.91 mL) of PA group were significantly less than CA group (mean duration time=285.34 min, mean blood loss=579.27 mL) (P<0.01). CONCLUSIONS Compared with to the CA approach and with the equally significant outcome, surgery by single PA was feasible and should be positively recommended for ASCSF patients, especially for those accompanying with a severe chin-on-chest deformity or poor physical conditions which restrain patients from tolerating a long surgery or major surgical trauma.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Hongquan Ji
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Zhishan Zhang
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Yan Guo
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Zhongwei Yang
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
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Liu M, Deng XL, Yu J. Effectiveness and safety of Chinese herbal formula combined with western medicine for ankylosing spondylitis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26374. [PMID: 34160412 PMCID: PMC8238346 DOI: 10.1097/md.0000000000026374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the spine, which mainly invades the sacroiliac joint, spine, and large joints near the trunk, leading to fibrous and skeletal ankylosis and deformity, and can cause damage to the eyes, lung, cardiovascular, kidney and other organs. Chinese herbal formulas (CHF) is an important interventions of Traditional Chinese Medicine (TCM), and CHFs combined with western medicine are widely used in clinical practice to treat AS. METHODS Eight databases will be systematically retrieved from their inceptions to March 2021. Only randomized controlled trials (RCTs) of CHFs combined with western medicine for AS treatment will meet the inclusion criteria. The primary outcomes we focus on include clinical effectiveness rate, TCM syndrome score, TCM symptom score, Bath ankylosing spondylitis disease activity index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion, nocturnal spinal pain, adverse reactions, erythrocyte sedimentation rate (ESR), and C protein response (CRP). The research screening, data extraction, and risk of bias assessment will be performed independently by 2 researchers, and divergence will be solved by a third researcher. Revman 5.3 software will be used for meta-analysis. The confidence of evidence will be graded using grading of recommendations assessment, development, and evaluation (GRADE) algorithm and methodological quality will be assessed adopting risk of bias in systematic reviews (ROBIS). RESULTS This systematic review (SR) will provide evidence-based medical evidence for AS therapy by CHF combined with western medicine and we will submit the findings of this SR for peer-review publication. CONCLUSIONS This SR will provide latest and updated summary proof for assessing the effectiveness and safety of CHF combined with western medicine for AS. REGISTRATION NUMBER INPLASY 202150089.
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Affiliation(s)
- Miao Liu
- Dalian Xigang Zhonghe Rheumatism and Immunology Specialist Outpatient Department of Integrated Traditional Chinese Medicine and Western Medicine, Dalian
| | | | - Jing Yu
- Department of Rheumatology and Immunology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
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20
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Ren C, Zhu Q, Yuan H. Imaging features of spinal fractures in ankylosing spondylitis and the diagnostic value of different imaging methods. Quant Imaging Med Surg 2021; 11:2499-2508. [PMID: 34079719 DOI: 10.21037/qims-20-962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Our study aimed to characterize the imaging appearance of spinal fractures in ankylosing spondylitis (AS) and identify situations in which the use of magnetic resonance imaging (MRI) is necessary. Methods A total of 70 cases of spinal fractures associated with AS were retrospectively enrolled. Two radiologists independently reviewed the preoperative images. The location, type, ligament injury, neurological injury, and epidural hematoma following spinal fractures were assessed. Results Only one patient had a vertebral compression fracture, and 69 patients had 77 transverse fractures involving three columns. The most frequent injuries in AS patients were type B3 (N=32, 43.8%) spine fractures, followed by type C (N= 20, 27.4%) spine fractures. There were significant differences in fracture types of the different spine regions (H=14.1, P<0.0001). Most type C spine fractures were located in the lower cervical spine, while most of the type B2 spine fractures were located in the thoracic spine. Transverse fractures were classified as shear or stress type fractures. In total, there were 62 shear fractures and 15 stress fractures. All of the transverse fractures were detected by computed tomography (CT). The accuracy of CT in the diagnosis of the exact anatomic involvement of transverse fractures was significantly higher than that of MRI (χ2=8.36, P=0.014). The anterior longitudinal ligament (ALL) was the most frequently torn ligament. Tears of ossified ligaments were best visualized by sagittal reformatted CT. Lower cervical fractures were more likely to be associated with neurological injury compared with fractures to other regions of the spine (χ2=7.24, P=0.025). There were six epidural hematoma cases, which were only detected by MRI, were found to have fractures of the lower cervical spine. Conclusions We recommend a whole-spine CT examination with three-dimensional reconstruction for detecting a suspected fracture in AS patients. In cases with neurological injury, MRI examinations are always mandatory. AS patients with lower cervical spine fractures require further investigation by MRI. Patients with non-lower cervical spine fractures without any neurological deficits do not need to undergo an immediate MRI.
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Affiliation(s)
- Cui Ren
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qiao Zhu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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21
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Buxbaum RE, Shani A, Mulla H, Rod A, Rahamimov N. Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures. J Orthop Surg Res 2021; 16:317. [PMID: 34001172 PMCID: PMC8127240 DOI: 10.1186/s13018-021-02420-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times. In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients. Methods We retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated. Results Twenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion. 45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days. All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction. Conclusions PMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.
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Affiliation(s)
| | - Adi Shani
- Department of Orthopedics B and Spine Surgery, Galilee Medical Center, Nahariya, Israel
| | - Hani Mulla
- Department of Orthopedics, Bnei-Zion Medical center, Haifa, Israel
| | - Alon Rod
- Department of Orthopedics B and Spine Surgery, Galilee Medical Center, Nahariya, Israel
| | - Nimrod Rahamimov
- Medical faculty, Bar-Ilan University, Safed, Israel. .,Department of Orthopedics B and Spine Surgery, Galilee Medical Center, Nahariya, Israel.
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22
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Guiot A, Estublier C, Gaude M, Szulc P, Chapurlat R. Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men. Rheumatology (Oxford) 2021; 60:2197-2205. [PMID: 33200181 DOI: 10.1093/rheumatology/keaa517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 07/09/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH. METHODS In 782 men ages 50-85 years, DISH was diagnosed using Resnick's criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records. RESULTS Men with DISH had higher BMD at the lumbar spine (P < 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P < 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P < 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P < 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P < 0.05), mainly in men with higher spine BMD (>0.9 g/cm2; ΔAUC = +0.189, P < 0.001). DISH was not associated with the risk of non-vertebral fracture. CONCLUSION DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.
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Affiliation(s)
- Anaïs Guiot
- Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.,Faculté de Médecine, Université Claude Bernard Lyon 1
| | - Charline Estublier
- INSERM UMR 1033, Hôpital Edouard Herriot, Pavillon F, Lyon.,Service de Rhumatologie, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Marine Gaude
- Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.,Faculté de Médecine, Université Claude Bernard Lyon 1
| | - Pawel Szulc
- INSERM UMR 1033, Hôpital Edouard Herriot, Pavillon F, Lyon
| | - Roland Chapurlat
- Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.,Faculté de Médecine, Université Claude Bernard Lyon 1.,INSERM UMR 1033, Hôpital Edouard Herriot, Pavillon F, Lyon
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23
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Zhang T, Wang Y, Zhang P, Xue F, Zhang D, Jiang B. Different fixation pattern for thoracolumbar fracture of ankylosing spondylitis: A finite element analysis. PLoS One 2021; 16:e0250009. [PMID: 33836027 PMCID: PMC8034711 DOI: 10.1371/journal.pone.0250009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
The objective of this study is to establish an ankylosing spondylitis (AS) thoracolumbar fracture finite element (FE) model and provide a proper posterior fixation choice from the biomechanical perspective. The ankylosing spondylitis T9-L5 FE model was built and the range of motion (ROM) was compared to previous studies. The L1 transverse fracture was simulated and was separately fixed by five different patterns. The pull force and yielding force of the screws, the von Mises stress of the internal fixation, and the displacement of fracture site were analyzed to evaluate the proper fixation pattern for thoracolumbar fracture of AS. ROM of AS model was obviously restricted comparing to the normal vertebral experimental data. All the fixation patterns can stabilize the fracture. At least four levels of fixation can reduce the von Mises stress of the internal fixation. Four levels fixation has a higher pull force than the six levels fixation. Skipped level fixation did not reduce the stress, pull force and yielding force. The kyphosis correction did not change the biomechanical load. At least 4 levels fixation was needed for AS thoracolumbar fracture. The cemented screws should be chosen in 4 levels fixation to increase the holding of the screws. The skipped fixation has no advantage. The kyphosis correction can be chosen after weighing the pros and cons.
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Affiliation(s)
- Tianyu Zhang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
| | - Yanhua Wang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
| | - Peixun Zhang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
- Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China
| | - Feng Xue
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
- Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China
- * E-mail:
| | - Dianying Zhang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
- Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China
- Department of Orthopaedics, Peking University Binhai Hospital, Tianjin, China
| | - Baoguo Jiang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
- Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China
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24
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Mareddu E, Traverso A, Laudato P, Bauer S. Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture. BMJ Case Rep 2021; 14:14/3/e236323. [PMID: 33649035 PMCID: PMC7929796 DOI: 10.1136/bcr-2020-236323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical 'Awareness Criteria' (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.
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Affiliation(s)
- Elisa Mareddu
- Orthopaedics and Trauma Surgery, EHC Morges, Morges, Switzerland
| | | | - Pietro Laudato
- Orthopaedics and Trauma Surgery, EHC Morges, Morges, Switzerland
| | - Stefan Bauer
- Orthopaedics and Trauma Surgery, EHC Morges, Morges, Switzerland
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25
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Prestat AJ, Gondim Teixeira PA, Rauch A, Loeuille D, Pretat PH, Louis M, Blum A. First intention vertebroplasty in fractures within an ankylosed thoracolumbar spinal segment. Diagn Interv Imaging 2021; 102:421-430. [PMID: 33549510 DOI: 10.1016/j.diii.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the outcome of percutaneous vertebral cementoplasty (PVC) as the first-line treatment for traumatic thoracolumbar fractures within an ankylosed spinal segment. MATERIALS AND METHODS Thirty-one patients (15 men, 16 women; mean age: 79.2±11 [SD] years; age range: 66-95 years) with thoracolumbar fractures within an ankylosed spine segment without neurological impairment treated with PVC were retrospectively evaluated. All patients were controlled at six weeks and one year after PVC. Ankylosing conditions, fractures sites and types, radiological consolidation, spinal complications were assessed. Anterior/posterior vertebral height ratios were measured before and after PVC. Postoperative pain relief and treatment success (radiological fracture consolidation) rates were considered. RESULTS The 31 patients had a total of 39 fractures (19 stable [49%], 20 unstable [51%]) treated with PVC. Primary success rate of PVC (initial fracture consolidation without complication) was 61% (19/31). Seven patients (7/31; 23%) exhibited new fractures, and the secondary success rate of PVC (global fracture consolidation one year after repeat PVC) was 87% (34/39). Global consolidation rates of unstable fractures were 85% (17/20) of treated levels. Pain score was null in 84% patients (26/31) one year after PVC. There were no significant differences between pre-PVC (0.62±0.18 [SD]; range: 0.22-0.88) and post-PVC (0.60±0.18 [SD]; range: 0.35-0.88) vertebral height ratios (P=0.94). CONCLUSION PVC conveys a high overall success rate and effectively controls pain in patients with vertebral fractures within ankylosed spine segments.
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Affiliation(s)
- Alexandre J Prestat
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France; Department of Musculoskeletal Radiology, Hôpital Pasteur 2, CHU de Nice, 06000 Nice, France.
| | | | - Aymeric Rauch
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Damien Loeuille
- Department of Rheumatology, Central Hospital, University Hospital Center of Nancy (CHRU-Nancy), 54511 Vandoeuvre-Lès-Nancy, France
| | - Pierre-Henri Pretat
- Department of Neurosurgery, Central Hospital, University Hospital Center of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Matthias Louis
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
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26
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Vierunen RM, Koivikko MP, Siironen JO, Kerttula LI, Bensch FV. Post-traumatic spinal hematoma in ankylosing spondylitis. Emerg Radiol 2021; 28:601-611. [PMID: 33452963 DOI: 10.1007/s10140-020-01881-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/03/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) in post-traumatic ankylosing spondylitis (AS) patients. METHODS A total of 2256 consecutive referrals for urgent and emergency MRI scans of the spine over a period of eight years and nine months were manually reviewed for any mentions indicating axial ankylosis and post-traumatic spinal hematoma. We found 164 patients with ankylosed spines complicated by spinal fracture, of whom 32 had AS. Of the 132 excluded patients, 80 had diffuse idiopathic skeletal hyperostosis (DISH). The primary outcome was the presence of spinal hematoma, and the secondary outcome was spinal canal narrowing and spinal cord impingement. Two musculoskeletal radiologists and one fellow in musculoskeletal radiology reviewed the images for the presence of spinal hematoma and related signal characteristics, blinded to one another and initial reports. RESULTS Of 28 post-traumatic AS patients, 19 had SEHs and five had spinal SSHs. There was a statistically significant difference between Frankel grades before and after surgery in respect of neurological improvement (p = 0.008). Patients who had radiologically proven spinal cord impingement showed more severe neurological deficits (p = 0.012). Hematomas with T1 heterogeneity showed a significantly increased delay (p = 0.047) between injury and imaging, while other signal characteristics were only approximate. CONCLUSIONS Both SEH and SSH are common complications in post-traumatic AS patients. Patients benefit from surgery, but the relevance of spinal hematoma as a separate factor causing neurological deficit remains unclear.
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Affiliation(s)
- Riku M Vierunen
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland.
| | - Mika P Koivikko
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Jari O Siironen
- Department of Neurosurgery, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Liisa I Kerttula
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Frank V Bensch
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
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27
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Perez Giraldo GS, Ortiz Garcia JG. Immune-Mediated Disorders Affecting the Spinal Cord and the Spine. Curr Neurol Neurosci Rep 2021; 21:3. [PMID: 33392785 PMCID: PMC7779105 DOI: 10.1007/s11910-020-01088-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To review the most recent advances and provide a description of the most common autoimmune diseases causing myelitis and selective spine disorders. The ultimate goal of this article is to facilitate the prompt recognition of these diseases. RECENT FINDINGS The recent discovery of biomarkers such as aquaporin 4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies has changed our understanding of autoimmune diseases affecting the spinal cord as well as their treatment and outcomes. Autoimmune neurology is an increasingly evolving field that encompasses a broad spectrum of autoimmune-inflammatory diseases of the central nervous system (CNS) and peripheral nervous system (PNS). Autoimmune disorders of the spinal cord are a heterogeneous group of myelopathies with a broad differential diagnosis and many of them have been recently identified. Prompt recognition of these myelopathies is important as some of them are treatable, which could improve patient outcomes and prevent disability.
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Affiliation(s)
- Gina S Perez Giraldo
- Department of Neurology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd. Suite 2547, Oklahoma City, OK, 73104, USA
| | - Jorge G Ortiz Garcia
- Department of Neurology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd. Suite 2547, Oklahoma City, OK, 73104, USA.
- Division of Critical Care Neurology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd. Suite 2547, Oklahoma City, OK, 73104, USA.
- Division of Stroke and Cerebrovascular Disorders, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd. Suite 2547, Oklahoma City, OK, 73104, USA.
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28
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Clunie G, Horwood N. Loss and gain of bone in spondyloarthritis: what drives these opposing clinical features? Ther Adv Musculoskelet Dis 2020; 12:1759720X20969260. [PMID: 33240403 PMCID: PMC7675871 DOI: 10.1177/1759720x20969260] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
The breadth of bone lesion types seen in spondyloarthritis is unprecedented in
medicine and includes increased bone turnover, bone loss and fragility,
osteitis, osteolysis and erosion, osteosclerosis, osteoproliferation of soft
tissues adjacent to bone and spinal skeletal structure weakness. Remarkably,
these effects can be present simultaneously in the same patient. The search for
a potential unifying cause of effects on the skeleton necessarily focuses on
inflammation arising from the dysregulation of immune response to
microorganisms, particularly dysregulation of TH17 lymphocytes, and
the dysbiosis of established gut and other microbiota. The compelling notion
that a common antecedent pathological mechanism affects existing bone and
tissues with bone-forming potential (entheses), simultaneously with variable
effect in the former but bone-forming in the latter, drives basic research
forward and focuses our awareness on the effects on these bone mechanisms of the
increasing portfolio of targeted immunotherapies used in the clinic.
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Affiliation(s)
- Gavin Clunie
- Cambridge University Hospitals NHS Foundation Trust, Box, 204 Hills Rd, Cambridge CB2 0QQ, UK
| | - Nicole Horwood
- Norwich Medical School, University of East Anglia, Norwich, UK
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29
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Pedersen V, Lampart A, Bingisser R, Nickel CH. Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence. Trauma Surg Acute Care Open 2020; 5:e000560. [PMID: 33178895 PMCID: PMC7640585 DOI: 10.1136/tsaco-2020-000560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/04/2020] [Indexed: 11/08/2022] Open
Abstract
Background Older individuals sustaining low-energy falls (LEF) and presenting to the emergency department (ED) demand straightforward diagnostic measures for injury detection. Plain radiography (XR) series for diagnosis of fall-related injuries are standard of care, but frequently subsequent CT examination is required for diagnostic assurance. A systematic database search of diagnostic accuracy of XR for detection of fractures in older LEF patients was performed. Methods We searched PubMed, Embase, Cochrane Library, WHO International Clinical Trial Platform, and Clinical trials.gov databases from inception to January 2020 for studies including older patients (≥65 years) with LEF and obtaining CT examination and XR of the skeleton in an ED setting. Results From 8944 references screened, 11 studies met the criteria for inclusion. Performance of XR for detection of fractures of the pelvic ring and hip was analyzed in nine studies, two studies investigated XR performance to detect rib fractures, and two studies compared diagnostic accuracy of thoracolumbar spine XR. Sensitivity estimates ranged from 10% to 58% and specificity estimates from 55% to 100%. Clinical and statistical heterogeneity was significant among included studies, with an overall considerable risk of bias. Discussion High-quality evidence on accurate imaging strategies in older patients with LEF is lacking to date. XR is missing a reasonable amount of fractures of the pelvic ring, rib cage, and thoracic and lumbar spine. However, the utility of first-line CT imaging and the benefit of diagnosing every fracture is unknown, demanding high-quality prospective trials considering patient-oriented outcome as well.
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Affiliation(s)
- Vera Pedersen
- Department for General, Trauma and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Alina Lampart
- Department of Internal Medicine, Upper Valais Hospital Center Visp Location, Visp, Valais, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
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30
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He X, Dong Y. Ankylosis progressive homolog upregulation inhibits cell viability and mineralization during fibroblast ossification by regulating the Wnt/β‑catenin signaling pathway. Mol Med Rep 2020; 22:4551-4560. [PMID: 33173993 PMCID: PMC7646822 DOI: 10.3892/mmr.2020.11576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/13/2020] [Indexed: 12/14/2022] Open
Abstract
Ankylosis progressive homolog (ANKH) is associated with fibroblast ossification in ankylosing spondylitis (AS). As the human ANKH gene is poorly characterized relative to its murine counterpart, the aim of the present study was to examine ANKH expression in ligament tissue isolated from patients with AS and the role played by this gene in AS‑associated fibroblast ossification. Fibroblasts were isolated from ligament tissue collected from patients with AS and ligament tissue from individuals with spinal cord fractures, then cultured. Fibroblasts from patients with AS were subsequently transfected with an ANKH overexpression vector, while those collected from individuals with spinal cord fractures were transfected with small interfering RNA specific for ANKH. Cell viability, apoptosis and mineralization were analyzed using MTT assays, flow cytometry and Alizarin Red staining, respectively. Furthermore, ANKH mRNA and protein expression levels were analyzed using reverse transcription‑quantitative PCR and western blotting analysis, respectively. The expression levels of osteogenesis markers, including alkaline phosphatase, osteocalcin, Runt‑related transcription factor 2, c‑Myc, as well as the β‑catenin signaling protein, were also determined using western blotting. The results of the present study revealed that ANKH protein expression levels were downregulated in AS total ligament tissue extract, compared with spinal fracture ligament. Moreover, the fibroblasts derived from patients with AS exhibited an increased viability and reduced apoptosis rates, compared with the fibroblasts from patients with spinal fracture. Notably, ANKH overexpression inhibited viability, mineralization and ossification, increased the phosphorylation of β‑catenin and downregulated β‑catenin and c‑Myc protein expression levels in fibroblasts from patients with AS. In addition, ANKH overexpression increased the ratio of p‑β‑catenin/β‑catenin in fibroblasts from patients with AS. By contrast, ANKH silencing in fibroblasts from patients with spinal fracture resulted in the opposite effect. In conclusion, the findings of the present study suggested that ANKH may inhibit fibroblast viability, mineralization and ossification, possibly by regulating the Wnt/β‑catenin signaling pathway.
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Affiliation(s)
- Xindong He
- Department of Spinal Surgery, The People's Hospital of Xinchang, Xinchang, Zhejiang 312500, P.R. China
| | - Yongqiang Dong
- Department of Spinal Surgery, The People's Hospital of Xinchang, Xinchang, Zhejiang 312500, P.R. China
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31
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Al Saiegh F, Leibold A, Mouchtouris N, Sabourin V, Stefanelli A, Franco D, Harrop J, Jallo J, Prasad S, Heller J. Robot-Assisted Instrumented Fusion of a T8-9 Extension Distraction Fracture and Epidural Hematoma Evacuation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E420-E421. [PMID: 32259253 DOI: 10.1093/ons/opaa061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Abstract
The utilization of robotics has been gaining increased popularity in spine surgery. It can be used to assist in pedicle screw insertion when anatomy is complex in deformity surgery, but is also helpful in degenerative spine as it can minimize tissue dissection and fluoroscopy use.1-6 We present an operative video that demonstrates the use of a robotic system (Globus Excelsius GPS, Audubon, Pennsylvania) for thoracic instrumentation in an unstable fracture. The patient we present is a 64-yr-old male who sustained a T8-9 distraction extension fracture after falling down a flight of stairs. His computed tomography (CT) scan showed ossification of the anterior longitudinal ligament making ankylosing spondylitis the likely underlying condition.7,8 His magnetic resonance imaging showed an epidural hematoma extending from T7 to T11. Due to the unstable nature of this fracture and the presence of the hematoma, informed consent was obtained and the patient underwent thoracic pedicle screw fixation from T7 to T11 and laminectomy for hematoma evacuation. A preoperative CT was done for screw trajectory planning. Paraspinal muscle dissection was limited to the hematoma level to allow for laminectomy and evacuation. After registration of the patient to the robotic system using C-arm fluoroscopy, pilot burr holes are drilled using a rigid robotic arm and with optical tracking in real time. This reduces the degrees of freedom and allows for higher precision of screw placement. To the authors' knowledge, this video is the first one to show the utilization of robotics for thoracic instrumentation in an acute fracture.
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Affiliation(s)
- Fadi Al Saiegh
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Victor Sabourin
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Anthony Stefanelli
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Daniel Franco
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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Lin L, Zhao L, Huo B, Zheng L, Yu R, Li W, Yang J. Membranous nephropathy and thymoma in a patient with ankylosing spondylitis: A case report. Medicine (Baltimore) 2020; 99:e20111. [PMID: 32358402 PMCID: PMC7440243 DOI: 10.1097/md.0000000000020111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE We report a rare case with ankylosing spondylitis (AS), thymoma, and membranous glomerulonephritis. The pathogenic mechanisms of these 3 diseases may be associated with each other. Here, we discuss the course of diagnosis and treatment. PATIENT CONCERNS A 64-year-old woman with bilateral pain of the sacroiliac joints for 10 years and anasarca for 10 days. DIAGNOSES A diagnosis of AS by HLA-B27 and pelvic X-ray tests, thymoma based on computed tomography and pathological diagnosis, and membranous glomerulonephritis based on renal biopsy. INTERVENTIONS We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD, for a month. OUTCOMES The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin/creatinine decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved, and the Bath Ankylosing Spondylitis Disease Activity Index score dropped to 4.0. LESSONS Although the causal relationship between AS, thymoma, and membranous nephropathy in this patient still needs to be established, the pathogenesis between the 3 diseases may have some association. In clinical practice, patients with AS need to be screened for tumors and renal complications.
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von der Höh NH, Henkelmann J, Jarvers JS, Spiegl UJA, Voelker A, Josten C, Heyde CE. Magnetic resonance tomography for the early detection of occult fractures of the spinal column in patients with ankylosing spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:870-878. [DOI: 10.1007/s00586-020-06309-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/29/2019] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
The purpose of this study was to determine the extent to which magnetic resonance imaging (MRI) performed in patients with ankylosing spondylitis (AS) after low- and no-energy trauma leads to an improved diagnosis and, as a result, to a change in the therapeutic strategy.
Methods
All patients with AS, who underwent surgery after minor traumas (low-energy traumas, LETs) and patients without trauma history (NET: no-energy trauma), were retrospectively analysed. The diagnostic and planned surgical procedure was examined initially and again after total spine MRI in patients with persistent and/or new complaints.
Results
One hundred and thirty-six patients with AS after trauma were surgically treated. A total of 92 patients with LETs and 12 patients with NETs were included. After initial diagnostics (CT and X-ray) were performed in 15.4% of the patients with LET or NET (n = 16), we found occult fractures on MRI scans. In ten of these patients (6 LET, 4 NET) in which a previous decision was made to follow conservative therapy, no fracture indication was found on CT or X-ray. Two fracture heights were observed in six patients who experienced LET. However, on X-ray and CT, the fractures were only visible at one height. All fractures were treated surgically with stabilization and decompression if indicated.
Conclusion
Considering the high percentage of our patient population with occult fractures, we recommend supplementing the basic diagnostic procedures with an MRI of the entire spinal column in patients with painful spinal column findings after minor trauma and for those with persistent pain without trauma.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
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Shlobin NA, Dahdaleh NS. Surgical Stabilization of a Cervical Fracture in a Patient with Ankylosing Spondylitis in the Sitting Position. Cureus 2020; 12:e6625. [PMID: 31966941 PMCID: PMC6957039 DOI: 10.7759/cureus.6625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Ankylosing spondylitis is a seronegative spondyloarthropathy promoting alteration of the integrity and biomechanics of the spine. This leads to a brittle and hyperkyphotic spine with an increased risk of cervical spine fracture. Cervical spine fractures in people with ankylosing spondylitis are often unstable three-column extension injuries that are managed with posterior long segment fusions. Kyphotic deformity, body habitus, and increased airway pressures complicate these procedures. A 65-year-old man presented with neck pain following a fall from a roof. He was found to have a displaced transverse three-column fracture of C6/7. The original plan was to perform a staged circumferential cervical fusion with anterior cervical fusion first to make prone positioning for posterior fusion safer. CT after anterior cervical fusion from C5 to C7 demonstrated improved alignment of the fractured posterior elements. Due to concern of increased peak airway pressures and awkward positioning, planned prone positioning for posterior approach was abandoned. A posterior long segment fusion from C4 to T3 was performed in the seated position. CT demonstrated the hardware was appropriately placed. The patient’s hospital course was uncomplicated, and he was followed up with cervical spine x-rays. Two years later, he denied neck pain or functional impairment and x-ray demonstrated healing of the fracture. Utilizing the sitting position for the posterior cervicothoracic fusion portion of a combined anterior-posterior approach can overcome complication-spurring positioning difficulties and provide proper surgical management of an unstable cervical spine fracture in a patient with ankylosing spondylitis.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine Northwestern University, Chicago, USA
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Wei JCC, Chen HH, Hsieh TY, Lan HHC, Tseng JC, Liu CH, Chen YC, Tsai WC, Wu HTH, Chou CT. Clinical practice recommendations for the use of imaging in the diagnosis and management of axial spondyloarthritis in Taiwan. Int J Rheum Dis 2019; 23:24-36. [PMID: 31833212 DOI: 10.1111/1756-185x.13679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is a chronic inflammatory disease bearing challenges in early diagnosis. To improve clinical diagnosis and management of axSpA, recommendations were developed with current axSpA classification criteria and recent advances in medical imaging applications. METHODS A systematic literature review was conducted by 10 rheumatologists and radiologists in Taiwan to retrieve research evidence on the utilization of imaging modalities, including conventional radiography (CR), magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US), quantitative sacroiliac scintigraphy (QSS), and dual-energy X-ray absorptiometry (DXA). The panel of experts proposed six key issues on the role of imaging in early diagnosis of axSpA, monitoring of disease activity and structural changes, predicting treatment effects, and assessing complications such as osteoporosis and spinal fracture. The consensus was established on the basis of research evidence, clinical experiences and expert opinions. For each recommendation statement, the level of evidence was evaluated, the strength of recommendation was graded and the final level of agreement was determined through voting. RESULTS In total, four overarching principles and 13 recommendations were formulated. These recommendations outlined different imaging approaches in the diagnosis and management of axSpA disease progression. Considering CT is easy to perform when MRI is less available in Taiwan, the expert panel proposed a concise and practical diagnostic scheme to strengthen the valuable role of MRI and CT in the diagnostic evaluation of axSpA without evident radiographic features. CONCLUSION These modified recommendations provide guidance for rheumatologists, radiologists and healthcare professionals on timely diagnosis of axSpA and disease management with appropriate imaging modalities.
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Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chun Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Clinical Training, Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.,Evidence-Based Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Jui-Cheng Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu Chi Hospital, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ying-Chou Chen
- Departments of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chan Tsai
- Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hung-Ta Hondar Wu
- Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Musculoskeletal Section, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice. Rheumatol Int 2019; 39:2119-2127. [DOI: 10.1007/s00296-019-04441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
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Min Y, Hui-Yun G, Hou-Cheng Z, Yuan-Long X, Wei J, Lin C, Ren-Xiong W. The surgical treatment strategies for thoracolumbar spine fractures with ankylosing spondylitis: a case report. BMC Surg 2019; 19:99. [PMID: 31349822 PMCID: PMC6660961 DOI: 10.1186/s12893-019-0565-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/18/2019] [Indexed: 02/01/2023] Open
Abstract
Background Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects spine and paraspinal soft tissue. Ankylosing spondylitis is one of the causes of osteoporosis and patients with ankylosing spondylitis tend to have spinal fractures due to limited mobility and osteoporosis. In recent years, due to the increase in the number of patients with AS, patients with AS and thoracolumbar spine fractures have gradually increased. In the past 1 year, we have treated 3 cases of AS with thoracolumbar spine fractures via simple posterior internal fixation and this paper aims to report its clinic effect. Case presentation All the three patients selected had a history of ankylosing spondylitis for nearly 30 years, and one of them developed a thoracolumbar spine fracture after falling when he walked, and the other two developed a thoracolumbar spine fracture without any reason. They were hospitalized for “low back pain” and were diagnosed as fractures after careful physical examination and imaging examinations such as X-ray, CT, and MRI. After the preoperative preparation was completed, all the three patients underwent surgery with simple posterior internal fixation-reduction of the fracture and pedicle screw fixation via posterior approach. All the implants-pedicle screws and connecting rods-are made of titanium alloy. For postoperative management, we asked all the patients to stay in bed for 3 weeks after the operation, and then slowly move down with the help of crutches. Fracture healing and neurological function recovery were observed postoperatively. All the three patients recovered satisfactorily after surgery, and the follow-up confirmed that the fracture healed successfully after 3 months. Conclusions The 3 patients included 2 men and 1 women. All the 3 patients recovered well after surgery, and the follow-up confirmed that the fracture healed successfully after 3 months. One man developed urination dysfunction after operation and recovered to normal 3 months after rehabilitation exercise.
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Affiliation(s)
- Yang Min
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China
| | - Gu Hui-Yun
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China
| | - Zhong Hou-Cheng
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China
| | - Xie Yuan-Long
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China
| | - Jin Wei
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China
| | - Cai Lin
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China
| | - Wei Ren-Xiong
- Department of spine, Zhongnan Hospital of Wuhan University, Donghu Road NO.169, Wuhan, Hubei, 430071, People's Republic of China.
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Ahammad Z, Milton J, Narayan K, Awuor V. Lateral position and utility of navigation for posterior fixation of unstable cervical fracture with ankylosing spondylitis. Surg Neurol Int 2018; 9:225. [PMID: 30533272 PMCID: PMC6238326 DOI: 10.4103/sni.sni_250_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/31/2018] [Indexed: 11/08/2022] Open
Abstract
Background: Ankylosing spondylitis (AS) is a seronegative spondyloarthropathy within the spectrum of rheumatologic diseases. The systemic inflammation that characterizes AS leads to bone resorption and reformation. Pathologic remodeling may include kyphosis, osteoporosis, and multi-segment auto-fusion. Cervical fractures account for 53–78% of spinal trauma seen with AS. Surgical planning is often challenging owing to spinal deformity, medical comorbidities, the cervicothoracic foci of injury, and gross instability of these fracture. Case Description: A 55-year-old male with AS was presented with a three-column injury at the C6 level. The C6 vertebra was fractured, minimally displaced, and there was a focal kyphotic deformity. Attempted posterior fixation 2 days after presentation was aborted; the patient could not tolerate prone positioning, and there were further technical limitations to a posterior approach. Cervicothoracic fixation from C2 to T2 was then performed using the right lateral decubitus position employing the Mayfield head holder, a beanbag, and spinal neuronavigation. Conclusion: In this study, we presented a unique approach to posterior fixation of an unstable cervicothoracic fracture in a patient with AS utilizing the lateral position and neural navigation under intraoperative physiological monitoring.
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Affiliation(s)
- Zubair Ahammad
- Grant Medical Center, Department of Neurosurgery, Ohio Health, Columbus, Ohio, USA
| | - Jason Milton
- Grant Medical Center, Department of Neurosurgery, Ohio Health, Columbus, Ohio, USA
| | - Kailash Narayan
- Grant Medical Center, Department of Neurosurgery, Ohio Health, Columbus, Ohio, USA
| | - Victor Awuor
- Grant Medical Center, Department of Neurosurgery, Ohio Health, Columbus, Ohio, USA
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Sekiguchi I, Takeda N, Ishida N. Diagonal Trajectory Posterior Screw Instrumentation for Compromised Bone Quality Spine: Groove-Entry Technique/Hooking Screw Hybrid. Spine Surg Relat Res 2018; 2:309-316. [PMID: 31435540 PMCID: PMC6690104 DOI: 10.22603/ssrr.2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/21/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction In an attempt to increase anchoring strength of posterior instrumentation in spine with compromised bone quality, we introduced diagonal trajectory pedicle screwing (hooking screws) that do not rely on screw thread purchase in bone but rather hook onto the strong posterior elements of vertebrae from inside the bone. Methods Between November 2016 and July 2017 we treated eight patients, mean age 80 years old (75-86 years old) with compromised bone quality for spinal instability. The diagnosis was osteoporotic fracture nonunion in three, ankylosed spine fracture in three, pyogenic spondylitis in two cases. All spines were percutaneously instrumented. Groove-entry technique was used for down-going thoracic screws. No additional hooks, cables, or any other augmentation was used. All patients were mobilized on post-operative day 1. Results 84 screws were inserted overall. Groove-entry technique was used for 42 screws insertion. On average, 5.3 spinal segments were fixed per case. Mean operation time was 252 min (46 min per one spinal segment). Mean intraoperative bleeding was 112 ml per case (21 ml per one fixed spinal segment). All cases achieved bony union of the fracture site or across the destroyed intervertebral disk. Mean time to union was 4 months postop (3-7 months). All patients were ambulatory at the time of discharge. No nerve injury, no skin irritation caused by implants, no screw loosening, no screw pullout, no loss of correction, and no junctional kyphosis were noted in this series. Conclusions Diagonal screw instrumentation (our hooking screws and groove-entry technique) appears to provide sufficient anchoring strength while being minimally invasive and possibly helpful in prevention of junctional kyphosis.
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Affiliation(s)
- Ivan Sekiguchi
- Department of Orthopedic Surgery, Hokuto Medical Corporation Hokuto Hospital, Obihiro, Japan
| | - Naoki Takeda
- Department of Orthopedic Surgery, Sapporo Orthopedic Cardiovascular Hospital, Sapporo, Japan
| | - Naoki Ishida
- Department of Orthopedic Surgery, Hokuto Medical Corporation Hokuto Hospital, Obihiro, Japan
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Reinhold M, Knop C, Kneitz C, Disch A. Spine Fractures in Ankylosing Diseases: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:56S-68S. [PMID: 30210963 PMCID: PMC6130102 DOI: 10.1177/2192568217736268] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY DESIGN Review of literature and case series. OBJECTIVES Update and review of current treatment concepts for spine fractures in patients with ankylosing spinal disorders. METHODS Case presentation and description of a diagnostic and therapeutic algorithm for unstable spinal injuries with an underlying ankylosing spinal disorder (ASD) of the cervical and thoracolumbar spine. RESULTS Nondisplaced fractures can be missed easily using conventional X-rays. Thus, computed tomography (CT) scans are recommended for all trauma patients with ASD. In doubt or presence of any neurologic involvement additional magnetic resonance imaging (MRI) scans should be obtained. Spine precautions should be maintained all times and until definitive treatment (<24 h). Nonoperative fracture treatment is not recommended given the mechanical instability of the most commonly seen fracture patterns (AOSpine B- and C-type, M2) in patients with ASD and inherent high risk of secondary neurologic deterioration. For patients with ankylosing spondylitis (AS) or diffuse idiopathic hyperostosis (DISH) sustaining cervical spine fractures, a combined anterior-posterior instrumentation for fracture fixation is recommended. Closed reduction and patient positioning can be challenging in presence of preexisting kyphotic deformities. In the thoracolumbar (TL) spine, a posterior instrumentation extending 2 to 3 levels above and below the fracture level is recommended to maintain adequate reduction and stability until fracture healing. Minimally invasive percutaneous pedicle screws and cement augmentation can help to minimize the surgical trauma and strengthen the construct stability in patients with diminished minor bone quality (osteopenia, osteoporosis). CONCLUSIONS Current concepts, treatment options, and recommendations of the German Orthopedic Trauma Society-Spine Section for spinal fractures in the ankylosed spine have been outlined.
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Affiliation(s)
- Maximilian Reinhold
- Klinikum Südstadt Rostock, Rostock, Germany,Maximilian Reinhold, Klinikum Südstadt Rostock, Department of Orthopaedic, Trauma and Hand Surgery, Südring 81, 18059 Rostock, Germany.
| | | | | | - Alexander Disch
- Medical University Dresden at the TU Dresden, Dresden, Germany
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Lu MC, Koo M, Lai NS. Incident Spine Surgery in Patients With Ankylosing Spondylitis: A Secondary Cohort Analysis of a Nationwide, Population-Based Health Claims Database. Arthritis Care Res (Hoboken) 2018; 70:1416-1420. [PMID: 29193835 DOI: 10.1002/acr.23478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the risk of the need for spine surgery, including cervical and lumbar spine surgeries in patients with ankylosing spondylitis (AS), compared with those without the disease. METHODS A secondary data analysis was conducted using population-based claims data from the Taiwan National Health Insurance Research Database. Adult patients with newly diagnosed AS between January 2000 and December 2012 were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification code 720.0. A comparison cohort was assembled using frequency-matched sex, 10-year age intervals, and index year with the AS cohort at a ratio of 5:1. All patients were followed until our study outcomes (any spine surgery, cervical spine surgery, and lumbar spine surgery), based on surgical codes, had occurred, or until the end of the followup period. Incidence rate ratios (IRRs) were calculated using Poisson regression models. RESULTS We identified 3,462 patients with AS and 17,310 patients without AS. All 3 outcome variables were seen at a significantly higher incidence in the AS cohort than in the comparison cohort (IRR 2.34 [95% confidence interval (95% CI) 1.92-2.87] for any spine surgery, IRR 2.36 [95% CI 1.55-3.59] for cervical spine surgery, and IRR 2.33 [95% CI 1.85-2.93] for lumbar spine surgery). Moreover, the magnitudes of the IRRs were the largest in the youngest age group (individuals in their 20s and 30s). CONCLUSION Patients with AS, particularly those in their 20s and 30s, had a significantly higher risk of needing any spine surgery, cervical spine surgery, and lumbar spine surgery, compared with patients without AS.
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Affiliation(s)
- Ming-Chi Lu
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Malcolm Koo
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ning-Sheng Lai
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan, School of Medicine, Tzu Chi University, Hualien City, Taiwan
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Van Mechelen M, Gulino GR, de Vlam K, Lories R. Bone Disease in Axial Spondyloarthritis. Calcif Tissue Int 2018; 102:547-558. [PMID: 29090349 DOI: 10.1007/s00223-017-0356-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023]
Abstract
Axial spondyloarthritis is a chronic inflammatory skeletal disorder with an important burden of disease, affecting the spine and sacroiliac joints and typically presenting in young adults. Ankylosing spondylitis, diagnosed by the presence of structural changes to the skeleton, is the prototype of this disease group. Bone disease in axial spondyloarthritis is a complex phenomenon with the coexistence of bone loss and new bone formation, both contributing to the morbidity of the disease, in addition to pain caused by inflammation. The skeletal structural changes respectively lead to increased fracture risk and to permanent disability caused by ankylosis of the sacroiliac joints and the spine. The mechanism of this new bone formation leading to ankylosis is insufficiently known. The process appears to originate from entheses, specialized structures that provide a transition zone in which tendon and ligaments insert into the underlying bone. Growth factor signaling pathways such as bone morphogenetic proteins, Wnts, and Hedgehogs have been identified as molecular drivers of new bone formation, but the relationship between inflammation and activation of these pathways remains debated. Long-standing control of inflammation appears necessary to avoid ankylosis. Recent evidence and concepts suggest an important role for biomechanical factors in both the onset and progression of the disease. With regard to new bone formation, these processes can be understood as ectopic repair responses secondary to inflammation-induced bone loss and instability. In this review, we discuss the clinical implications of the skeletal changes as well as the underlying molecular mechanisms, the relation between inflammation and new bone formation, and the potential role of biomechanical stress.
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Affiliation(s)
- Margot Van Mechelen
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Division of Rheumatology, UZ Leuven, Herestraat 49, B3000, Leuven, Belgium
| | - Giulia Rossana Gulino
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, UZ Leuven, Herestraat 49, B3000, Leuven, Belgium
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
- Division of Rheumatology, UZ Leuven, Herestraat 49, B3000, Leuven, Belgium.
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Walsh JA, Song X, Kim G, Park Y. Evaluation of the comorbidity burden in patients with ankylosing spondylitis using a large US administrative claims data set. Clin Rheumatol 2018; 37:1869-1878. [PMID: 29637483 PMCID: PMC6006197 DOI: 10.1007/s10067-018-4086-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/15/2018] [Accepted: 03/27/2018] [Indexed: 01/17/2023]
Abstract
Comorbidities among US patients with ankylosing spondylitis (AS) are inadequately understood. This study compared the prevalence and incidence of comorbidities between patients with AS and matched controls using national claims databases. Adults enrolled in the MarketScan Commercial and Medicare databases with ≥ 1 inpatient or ≥ 2 non-rule-out outpatient diagnoses of AS between January 1, 2012 and December 31, 2014 were included. Patients had to have ≥ 1 AS diagnosis in 2013; the first AS diagnosis in 2013 was assigned as the index date. Control patients without AS were matched to AS patients on age, geographic region, index calendar year, and sex. Comorbidities were evaluated in AS patients and matched controls during the baseline and follow-up periods (before and after the index date, respectively). Hazard ratios of developing new comorbidities were estimated using Cox proportional hazard models adjusted for patients’ characteristics. A total of 6679 patients with AS were matched to 19,951 control patients. In addition to extra-articular manifestations of AS (inflammatory bowel disease [IBD], psoriasis, uveitis), a higher proportion of AS patients had asthma, cardiovascular disease, depression, dyslipidemia, gastrointestinal ulcers, malignancies, multiple sclerosis, osteoporosis, sleep apnea, and spinal fractures during the baseline period than matched controls. After AS diagnosis, a higher proportion of patients developed newly diagnosed cases of cardiovascular diseases, depression, osteoporosis, spinal fracture, IBD, psoriasis, and uveitis than matched controls. In this real-world, US claims-based study, patients with AS were shown to have significantly more comorbidities than matched controls.
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Affiliation(s)
- Jessica A Walsh
- Division of Rheumatology, University of Utah School of Medicine and Salt Lake City Veteran Affairs Medical Center, Salt Lake City, UT, USA
| | - Xue Song
- Truven Health Analytics, an IBM Company, 75 Binney Drive, Cambridge, MA, 02142, USA.
| | - Gilwan Kim
- Truven Health Analytics, an IBM Company, 75 Binney Drive, Cambridge, MA, 02142, USA
| | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Zhang M, Li XM, Wang GS, Tao JH, Chen Z, Ma Y, Li XP. The association between ankylosing spondylitis and the risk of any, hip, or vertebral fracture: A meta-analysis. Medicine (Baltimore) 2017; 96:e8458. [PMID: 29390254 PMCID: PMC5815666 DOI: 10.1097/md.0000000000008458] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is an inflammatory rheumatic disease and strongly associated with an increased risk of fractures. A great proportion of patients with AS are suffering from sustaining fractures and the aim of this study is to evaluate and quantify the association between the site of the fracture and AS by performing a meta-analysis. METHODS A systematic literature search was performed on Medline database from 1966 to August 15, 2016 and Embase database from 1980 to August 15, 2016. Studies were evaluated by 2 independent reviewers and quantitative estimates regarding the association between ankylosing spondylitis and the risk of any, hip, or vertebral fracture were presented. After the heterogeneity of selected studies was assessed by using Cochran I statistics, the random effect model was used to combine effect size. Publication bias was measured by Egger and Begg's regression tests. RESULTS A total of 6 articles were involved in our study. The results of meta-analysis revealed that AS was strongly associated with the risk of vertebral fracture (odds ratio [OR] = 4.25, 95% confidence interval [CI] = 1.07-7.42) and was not significantly associated with the risk of any fracture (OR=2.00, 95%CI = 0.94-3.06) or hip fracture (OR=1.28, 95%CI =0.16-2.40). CONCLUSION In the present study, a general knowledge of the association between AS and the risk of 3 kinds of fractures were presented, which could improve the ways of prevention of fracture in the patients with AS.
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Zhu R, Song W, Hu W, Jiang Z, Yuan J, Cui Z, Wan J, Liu Y, Feng S, Zhang X. The treatment strategies for spine fractures in patients with ankylosing spondylitis: A case report. Medicine (Baltimore) 2017; 96:e8462. [PMID: 29095296 PMCID: PMC5682815 DOI: 10.1097/md.0000000000008462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aim of the study was to explore surgical strategies for effectively treating spine fractures in patients with ankylosing spondylitis (AS) and investigate the postoperative outcomes. METHODS We retrospectively analyzed 9 patients with AS that was complicated by spine fractures, who underwent surgery at our spine and spinal cord clinic between 2005 and 2012. The surgical methods included posterior instrumentation and bone grafting, with or without decompression. Fracture healing and neurological function recovery were observed postoperatively. The average follow-up period was 45.1 months (range: 24-60). RESULTS The 9 patients included 7 men and 2 women. Eight patients were treated with long posterior fixation. One patient underwent combined long posterior fixation and anterior bone grafting. The neurological function of these patients improved significantly to varying degrees after surgery, and fracture union and segmental instability of the lumbar vertebrae were radiologically confirmed at the 1-month and 2-year follow-up intervals. Severe surgery-related complications were not observed. CONCLUSIONS Posterior instrumentation with bone grafting was a satisfying method for treating spine fractures in patients with AS.
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Affiliation(s)
- RuSen Zhu
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - WenYe Song
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Wei Hu
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - ZeHua Jiang
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - JianJun Yuan
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - ZiJian Cui
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - Jun Wan
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - Yan Liu
- Department of Spine Surgery, Tianjin Union Medicine Centre
| | - ShiQing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - XueLi Zhang
- Department of Spine Surgery, Tianjin Union Medicine Centre
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González C, Curbelo Rodríguez R, Torre-Alonso JC, Collantes E, Castañeda S, Hernández MV, Urruticoechea-Arana A, Nieto-González JC, García J, Abad MÁ, Ramírez J, Suárez C, Dalmau R, Martín-Arranz MD, León L, Hermosa JC, Obaya JC, Otón T, Carmona L. Recommendations for the Management of Comorbidity in Patients With Axial Spondyloarthritis in Clinical Practice. ACTA ACUST UNITED AC 2017; 14:346-359. [PMID: 28461161 DOI: 10.1016/j.reuma.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/10/2017] [Accepted: 03/19/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective. METHODS A multidisciplinary group was selected (10 rheumatologists-six of them experts in AxSpA-, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panelists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panelists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted. RESULTS The final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favoring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA. CONCLUSIONS Two checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses.
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Affiliation(s)
- Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Eduardo Collantes
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Santos Castañeda
- Servicio de Reumatología, Hospital Universitario La Princesa IIS-Princesa, Madrid, España
| | | | | | | | - Javier García
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Miguel Ángel Abad
- Unidad de Reumatología, Hospital Virgen del Puerto, Plasencia, España
| | - Julio Ramírez
- Servicio de Reumatología, Hospital Clínic, Barcelona, España
| | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - Regina Dalmau
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | | | - Leticia León
- IdISSC Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, España
| | | | | | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España
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