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Liu P, Zhu H, Xie J. Thoracic-vertebra fracture with spinal epidural hematoma in patient with ankylosing spondylitis. Asian J Surg 2024; 47:2910-2911. [PMID: 38395708 DOI: 10.1016/j.asjsur.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Affiliation(s)
- Pingan Liu
- Medical Imaging Center, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Hao Zhu
- Medical Imaging Center, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Jingjing Xie
- Medical Imaging Center, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China.
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Goh BC, Pinter ZW, Wellings EP, Bernatz JT, Kolz JM, Sebastian AS, Elder BD, Freedman BA. Fractures in the ankylosed spine are associated with poor bone quality and lower hounsfield units. Clin Neurol Neurosurg 2023; 235:108048. [PMID: 37979561 DOI: 10.1016/j.clineuro.2023.108048] [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: 08/28/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
STUDY DESIGN Retrospective study INTRODUCTION: Patients with ankylosing spinal disorders have a higher risk of fractures, highlighting the need for bone health surveillance. Bone assessment by dual energy x-ray absorptiometry (DXA) is challenging due to abnormal bone formation but measurements by quantitative computed tomography (qCT) have demonstrated higher sensitivity and specificity. However, no studies have analyzed bone quality using qCT in the ankylosed spine population to assess three-column fracture characteristics and subsequent outcomes. METHODS 106 patients with 115 three-column fractures were identified from 1999 to 2020. Patient demographics, Charlson comorbidity index, and injury severity score were extracted. Bone quality measured in Hounsfield units (HU), fracture characteristics, neurologic injury, and mortality were obtained. RESULTS Most injuries occurred in the thoracic spine (70.4%) following a ground level fall (60.5%). HU adjacent to the fracture (127 HU) was significantly lower than the mobile segments (173 HU) (p < 0.001). Fracture adjacent HU was significantly lower in AS patients compared to DISH (109 vs 150 HU, p = 0.02, respectively) and were lower in fractures that resulted in a non-union or revision surgery (88 vs 137 HU, p = 0.04). Patients with longer fused segments were associated with multilevel and displaced fractures. CONCLUSIONS Fracture adjacent HUs within the autofused segments were significantly lower than in the mobile segments, and longer fusion segments were associated with displaced, multilevel fractures. This study reinforces the importance of assessing patients for decreased HUs as well as better understand how the length of fused segments is associated with displaced, multilevel fractures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Brian C Goh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Zachariah W Pinter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - James T Bernatz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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Ohshima K, Nakashima H, Segi N, Ito S, Ouchida J, Takegami Y, Ishizuka S, Hasegawa Y, Imagama S. The prevalence and characteristics of diffuse idiopathic skeletal hyperostosis in the community-living middle-aged and elderly population: The Yakumo study. J Orthop Sci 2023:S0949-2658(23)00277-4. [PMID: 37872071 DOI: 10.1016/j.jos.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/04/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The incidence of diffuse idiopathic skeletal hyperostosis (DISH) is increasing with the aging of the population. Asymptomatic DISH can decrease the spinal range of motion (ROM) and cause fractures. However, the prevalence or physical function of patients with DISH before experiencing fractures and other serious conditions is unclear. This study aimed to investigate the prevalence of DISH in the community residents on the basis of age and sex and characterize their physical function, ROM, and bone fragility. METHODS The subjects were community volunteers who attended a health checkup in 2018 and 2019. Overall, 455 subjects (mean age, 64.2 ± 9.7 years; 177 men) were included for analysis. We performed whole-spine lateral radiography for detecting DISH according to the criteria reported by Resnick. We compared the age, sex, body mass index (BMI), results of muscle strength and walking tests, ROM measured by SpinalMouse®, and quantitative ultrasound (QUS) of calcaneus with and without DISH. RESULTS DISH was detected in 83 (18.2%) cases. The DISH group was older (69.8 y.o. vs. 63.0 y.o.; p < 0.05) and comprised more men (prevalence: men, 27.7%; women, 12.2%; p < 0.001). BMI was high in the DISH group (24.8 vs. 23.3 kg/m2, p < 0.05). SpinalMouse measurements showed the DISH group had a significantly decreased ROM in the lumbar spine (43.2°, 57.2°, p < 0.05). The DISH group had a significantly lower T-score on the QUS measurement in the calcaneus (-2.0, -1.5, p < 0.05). There were, however, no significant differences between groups in both muscle strength test and walking test. CONCLUSION Subjects with DISH had decreased ROM in the lumbar spine and bone mineral density in calcaneal QUS. However, physical functions such as muscle strength and walking ability were similar among subjects with and without DISH without subjective symptoms.
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Affiliation(s)
- Kazuma Ohshima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan-shi, Aichi, 483-8704, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan-shi, Aichi, 483-8704, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan-shi, Aichi, 483-8704, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, 3-11-1 Asashigaoka, Kashiwara-shi, Osaka, 582-0026, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
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Bai H, Li Y, Huang X, Tan Q, Ma X, Wang Q, Wang L, Chen X, Wang B, Xiang L, Liu H, Ma X, Liu X, Jiang Z, Wu A, Cai W, Liu P, Mao N, Lu M, Wan Y, Zang X, Li S, Liao B, Zhao S, Fu S, Xie Y, Yu H, Song R, Ma Z, Yan M, Chu J, Sun J, Liu X, Feng Y, Dong Y, Hao D, Lei W, Wu Z. Can a Nomogram Predict Survival After Treatment for an Ankylosing Spondylitis Cervical Fracture in a Patient With Neurologic Impairment? A National, Multicenter Study. Clin Orthop Relat Res 2023; 481:1399-1411. [PMID: 36728053 PMCID: PMC10263251 DOI: 10.1097/corr.0000000000002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankylosing spondylitis-related cervical spine fracture with neurologic impairment (ASCF-NI) is a rare but often lethal injury. Factors independently associated with survival after treatment remain poorly defined, and identifying patients who are likely to survive the injury remains challenging. QUESTIONS/PURPOSES (1) What factors are independently associated with survival after treatment among patients with ASCF-NI? (2) Can a nomogram be developed that is sufficiently simple for clinicians to use that can identify patients who are the most likely to survive after injury? METHODS This retrospective study was conducted based on a multi-institutional group of patients admitted and treated at one of 29 tertiary hospitals in China between March 1, 2003, and July 31, 2019. A total of 363 patients with a mean age of 53 ± 12 years were eventually included, 343 of whom were male. According to the National Household Registration Management System, 17% (61 of 363) died within 5 years of injury. Patients were treated using nonsurgical treatment or surgery, including procedures using the anterior approach, posterior approach, or combined anterior and posterior approaches. Indications for surgery included three-column injury, unstable fracture displacement, neurologic impairment or continuous progress, and intervertebral disc incarceration. By contrast, patients generally received nonsurgical treatment when they had a relatively stable fracture or medical conditions that did not tolerate surgery. Demographic, clinical, and treatment data were collected. The primary study goal was to identify which factors are independently associated with death within 5 years of injury, and the secondary goal was the development of a clinically applicable nomogram. We developed a multivariable Cox hazards regression model, and independent risk factors were defined by backward stepwise selection with the Akaike information criterion. We used these factors to create a nomogram using a multivariate Cox proportional hazards regression analysis. RESULTS After controlling for potentially confounding variables, we found the following factors were independently associated with a lower likelihood of survival after injury: lower fracture site, more-severe peri-injury complications, poorer American Spinal Injury Association (ASIA) Impairment Scale, and treatment methods. We found that a C5 to C7 or T1 fracture (ref: C1 to C4 and 5; hazard ratio 1.7 [95% confidence interval 0.9 to 3.5]; p = 0.12), moderate peri-injury complications (ref: absence of or mild complications; HR 6.0 [95% CI 2.3 to 16.0]; p < 0.001), severe peri-injury complications (ref: absence of or mild complications; HR 30.0 [95% CI 11.5 to 78.3]; p < 0.001), ASIA Grade A (ref: ASIA Grade D; HR 2.8 [95% CI 1.1 to 7.0]; p = 0.03), anterior approach (ref: nonsurgical treatment; HR 0.5 [95% CI 0.2 to 1.0]; p = 0.04), posterior approach (ref: nonsurgical treatment; HR 0.4 [95% CI 0.2 to 0.8]; p = 0.006), and combined anterior and posterior approach (ref: nonsurgical treatment; HR 0.4 [95% CI 0.2 to 0.9]; p = 0.02) were associated with survival. Based on these factors, a nomogram was developed to predict the survival of patients with ASCF-NI after treatment. Tests revealed that the developed nomogram had good performance (C statistic of 0.91). CONCLUSION The nomogram developed in this study will allow us to classify patients with different mortality risk levels into groups. This, coupled with the factors we identified, was independently associated with survival, and can be used to guide more appropriate treatment and care strategies for patients with ASCF-NI. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Hao Bai
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Yaobin Li
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Xinyi Huang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Quanchang Tan
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Xuexiao Ma
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Qingde Wang
- Department of Spine Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, PR China
| | - Linfeng Wang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, PR China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Bing Wang
- The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - Liangbi Xiang
- Department of Orthopaedics, the General Hospital of Northern Theater Command, Shenyang, PR China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Sichuan, PR China
| | - Xiaomin Ma
- General Hospital of Ningxia Medical University, Yinchuan, PR China
| | - Xinyu Liu
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, PR China
| | - Zhensong Jiang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China
| | - Aimin Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Weidong Cai
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Peng Liu
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, PR China
| | - Ningfang Mao
- Department of Spinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Ming Lu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yong Wan
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Xiaofang Zang
- The Third Xiangya Hospital of Central South University, Changsha, PR China
| | - Songkai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, PR China
| | - Bo Liao
- Department of Orthopaedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, PR China
| | - Shuai Zhao
- Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, PR China
| | - Suochao Fu
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou, PR 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, PR China
| | - Haiyang Yu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang, PR China
| | - Ruoxian Song
- Department of Orthopedics, PLA 960th Hospital, Jinan, PR China
| | - Zhensheng Ma
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Ming Yan
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Jianjun Chu
- Department of Spine Surgery, Hefei Orthopaedics Hospital, Hefei, PR China
| | - Jiangbo Sun
- Shaoyang Zhenggu Hospital, Shaoyang, PR China
| | - Xiang Liu
- Hebei Aidebao Hospital, Zhengzhou, Langfang, PR China
| | - Yafei Feng
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Yuan Dong
- Department of Cardiology, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Wei Lei
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
| | - Zixiang Wu
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi’an, PR China
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Miyake T, Okada H, Kanda N, Mizuno Y, Suzuki K, Doi T, Yoshida T, Yoshida S, Ogura S. Spinal injury with spinal ankylosing disorders as a primary cause of death: report of two cases. Int J Emerg Med 2023; 16:7. [PMID: 36797663 PMCID: PMC9933250 DOI: 10.1186/s12245-023-00488-y] [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: 11/01/2022] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Spinal ankylosing disorders (SADs) refer to a group of conditions resulting in spontaneous or postsurgical ossification and fusion of the spinal segments. The spine becomes increasingly susceptible to injury over time such that even low-energy trauma can cause a spinal injury. We report two cases of SADs, associated with massive thoracic hemorrhage. CASE PRESENTATION The first patient was an 85-year-old male, who suffered from a vehicular crash. He was diagnosed with a fracture of the first lumbar vertebra, accompanied by SADs. Intubation was required, and thoracic drainage tubes were inserted. The patient underwent a massive transfusion and thoracotomy with packing. Despite prompt treatment, the hemorrhage from the vertebral fracture was uncontrolled, and the patient died 180 min after the injury. The second case features an 88-year-old male who fell from a height. He was diagnosed with flail chest, hemothorax, pneumothorax, and a fracture of the eighth thoracic vertebra with SADs. After intubation, four thoracic drainage tubes were placed, and a massive transfusion was conducted. He died after 3 days due to hypoxemia secondary to persistent bleeding of the vertebral fracture for 24 h. CONCLUSIONS The patients died of persistent thoracic hemorrhage, and the sources of bleeding were the fracture site of the spine fractures. Controlling spinal hemorrhage is difficult due to the absence of a bleeding artery, which is managed via trans-arterial embolization. This report emphasized that fracture of SADs could be a fatal disease that requires prompt intervention.
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Affiliation(s)
- Takahito Miyake
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hideshi Okada
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Norihide Kanda
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yosuke Mizuno
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Kodai Suzuki
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Tomoaki Doi
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Takahiro Yoshida
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Shozo Yoshida
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Abuse Prevention Emergency Medicine, Gifu University Graduate School of Medicine, Gifu, 501-1194 Japan
| | - Shinji Ogura
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
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Ye J, Jiang P, Guan H, Wei C, Li S, Jia M, Li N. Surgical treatment of thoracolumbar fracture in ankylosing spondylitis: A comparison of percutaneous and open techniques. J Orthop Surg Res 2022; 17:504. [PMID: 36434588 PMCID: PMC9694850 DOI: 10.1186/s13018-022-03378-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/30/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND CONTEXT Posterior percutaneous long-segment internal fixation and open fixation with long-segment screws have been used to treat thoracolumbar fractures in ankylosing spondylitis patients. PURPOSE To observe the clinical effect of posterior percutaneous long-segment internal fixation in 26 ankylosing spondylitis (AS) patients with thoracolumbar fractures. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Forty-seven AS patients who were diagnosed with thoracolumbar fractures and treated from December 2014 to December 2018. OUTCOME MEASURES Visual analog scale score, Cobb angle, American Spinal Injury Association Grade, SF-Qualiveen score, pedicle screw misplacement rate, operative duration, blood loss, complications, bed rest duration and modified MacNab score. METHODS All patients were divided into the percutaneous group (PG) and the open group. Twenty-six patients were treated with percutaneous long-segment internal fixation, and the remaining 21 underwent open fixation with long-segment screws. The minimum follow-up period was 12 months. RESULTS The operations were successful in both groups. A patient in the PG showed class C wound healing, while the others showed class A healing, and some patients experienced perioperative complications. All patients were followed up for 12-48 months (mean, 33.81 months), and all patients showed clinical osseous fracture healing. Significant differences were found in operative duration, intraoperative blood loss and postoperative bed rest duration between the two groups (P < 0.05). No significant difference was found in improvement of the visual analog scale score, Cobb angle of spinal kyphosis or neurological function after the operation (P > 0.05). CONCLUSIONS As a minimally invasive procedure, posterior percutaneous long-segment internal fixation requires less time, results in less blood loss and causes less trauma. This procedure can also improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to those of traditional methods. With this curative clinical effect, this procedure can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients, especially for elderly patients with underlying diseases and high surgical risk.
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Affiliation(s)
- JingYao Ye
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ping Jiang
- grid.412540.60000 0001 2372 7462Department of Orthopaedics, Shanghai University of Traditional Chinese Medicine, Shanghai, China ,grid.412540.60000 0001 2372 7462Department of Orthopaedics, Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - HuaPeng Guan
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - ChuanFu Wei
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Sen Li
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - MengLong Jia
- grid.461885.6Department of Orthopaedics, Weifang Hospital of Traditional Chinese Medicine, Weifang, China
| | - NianHu Li
- grid.464402.00000 0000 9459 9325Department of Orthopaedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Taher AW, Page PS, Greeneway GP, Ammanuel S, Bunch KM, Meisner L, Hanna A, Josiah D. Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21689. [PMID: 36303482 PMCID: PMC9379645 DOI: 10.3171/case21689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH) are considered highly unstable injuries with high risk for neurological injury. Surgical intervention is the standard of care for these patients to avoid secondary spinal cord injuries. Despite this, certain cases may necessitate a nonoperative approach. Herein within, the authors describe three cases of cervical, thoracic, and lumbar fractures in the setting of DISH that were successfully treated via orthosis. OBSERVATIONS The authors present three cases of fractures in patients with DISH. A 74-year-old female diagnosed with an acute fracture of a flowing anterior osteophyte at C6–C7 treated with a cervical orthosis. A 78-year-old male with an anterior fracture of the ankylosed T7–T8 vertebrae managed with a Jewett hyperextension brace. Finally, a 57-year-old male with an L1–L2 disc space fracture treated with a thoraco-lumbo-sacral orthosis. All patients recovered successfully. LESSONS In certain cases, conservative treatment may be more appropriate for fractures in the setting of DISH as an alternative to the surgical standard of care. Most fractures in the setting of DISH are unstable, therefore it is necessary to manage these patients on a case-by-case basis.
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Affiliation(s)
- Ayman W. Taher
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin; and
| | - Paul S. Page
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Garret P. Greeneway
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Simon Ammanuel
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Katherine M. Bunch
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Lars Meisner
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Amgad Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Darnell Josiah
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
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Grunert P, Drazin D. Editorial. Trauma in patients with spinal ankylosing disorders is often underestimated and frequently overlooked despite the high likelihood of complications. Neurosurg Focus 2021; 51:E3. [PMID: 34598126 DOI: 10.3171/2021.7.focus21436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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