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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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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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Classification and Treatment for Cervical Spine Fracture with Ankylosing Spondylitis: A Clinical Nomogram Prediction Study. Pain Res Manag 2022; 2022:7769775. [PMID: 35281345 PMCID: PMC8916892 DOI: 10.1155/2022/7769775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Objective Through the follow-up analysis of cervical spine fracture cases with ankylosing spondylitis (AS), a treatment-oriented fracture classification method is introduced to evaluate the clinical efficacy guided by this classification method. Method A retrospective analysis was performed on 128 AS patients who underwent comprehensive treatment in the Spine Surgery Department of Qingdao University Hospital from January 2009 to May 2018. Statistics of patient demographic data, distribution of different fractures corresponding to surgical methods, 3-year follow-up outcomes, and summary of objective fracture classification methods were analyzed. A prospective 5-year follow-up study of 90 patients with AS cervical spine fractures from June 2015 to August 2020 was also included. Statistical differences on the distribution of factors such as case information, cervical spine sagittal sequence parameters, and fracture classification were assessed. Correlations between surgical information, American Spinal Injuries Association grade (ASIA), modified Japanese Orthopaedic Association scores (mJOA), and other factors were analyzed to establish a nomogram predictive model for curative effect outcomes. Overall, three major types and the four subtypes of AS cervical spine fractures were evaluated based on the clinical efficacy of the classification and the selection of surgical treatment methods. Result The most common type of fracture was type II (30 cases, 33.33%), most of the subtypes were A (37 cases), followed by B (36 cases) and C (17 cases). Twenty-four of 28 patients with type I underwent anterior surgery, and 47 of 62 patients with type II and III underwent posterior surgery. The average follow-up time was 25.76 ± 11.80 months. The results of predicting clinical variables are different but include factors such as fracture type and subtype, type of operation, and age. The predictor variables include the above-mentioned similar variables, but survival is more affected by the fracture type of the patient. Conclusion This predictive model based on follow-up information delineation points out the impact of ankylosing spondylitis cervical spine fracture classification on surgical selection and clinical efficacy.
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Guo Q, Cui Y, Wang L, Lu X, Ni B. Single anterior approach for cervical spine fractures at C5-T1 complicating ankylosing spondylitis. Clin Neurol Neurosurg 2016; 147:1-5. [PMID: 27239896 DOI: 10.1016/j.clineuro.2016.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the outcomes of anterior approach for cervical spine fractures at C5-T1 in patients with ankylosing spondylitis (AS) and study the problems encountered in diagnosis and treatment. PATIENTS AND METHODS Ten patients with AS (all males; mean age 43.7±9.4 years) underwent anterior surgeries to treat fractures at C5-T1. Skull tractions were performed on patients with fracture dislocation preoperatively. After operation, all the patients wore a cervical collar for 3 months. Plain radiographs at follow-up were reviewed. If bone fusion could not be confirmed on plain radiograph, CT scan was employed. The pre- and postoperative neurological statuses were evaluated according to the Frankel grading system. Problems encountered in diagnosis and treatments were analyzed. RESULTS The mean follow-up was 41.2±22.7months. After operation, the displacements of fractures were significantly reduced(P<0.05). Bone fusions were observed in 9 patients at final follow-up. Frankel grades improved by 1.0±0.7 grade (P>0.05). Posterior complications occurred in four patients, including implants failure (n=1), subsidence of cage (n=1), hoarse voice (n=1) and pneumonias (n=2). The patient with implants failure required revision surgery and anterior-posterior fixation. Patient with subsidence of the titanium cage achieved bone fusion with prolonged cervical collar immobilization. CONCLUSION The diagnosis and treatment of cervical spine fractures at C5-T1 in AS patients are challenging, with high risk of neurological compromise and postoperative complications. The single anterior approach followed by postoperative immobilization with a cervical collar can yield acceptable results if the cases are properly selected.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Yidong Cui
- Department of Orthopedics, Qilu Hospital of Shandong University, People's Republic of China
| | - Liang Wang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Xuhua Lu
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
| | - Bin Ni
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
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Sebastian AS, Fogelson JL, Dekutoski MB, Nassr AN. Multiple noncontiguous spinal fractures and occipitocervical dislocation in a patient with ankylosing spondylitis treated with a hybrid open and percutaneous spinal fixation technique: a case report. Spine J 2015; 15:e1-5. [PMID: 25666695 DOI: 10.1016/j.spinee.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 01/06/2015] [Accepted: 02/03/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal fractures occur with a greater frequency in ankylosing spondylitis (AS) patients. Treatment of these fractures is complicated because of a higher incidence of medical comorbidities, higher rate of neurologic deficits, and higher risk of neurologic deterioration. PURPOSE To report a case report of a novel, combined open and percutaneous surgical techniques used for the treatment of multiple noncontiguous spinal fractures in a patient with AS. STUDY DESIGN/SETTING We describe the surgical treatment and the outcome of a patient with AS that sustained an occipitocervical dislocation and two noncontiguous three-column extension injuries using a hybrid technique with open occipital to T3 fusion and percutaneous T5-L1 instrumentation at a tertiary care facility. PATIENT SAMPLE A 77-year-old man with multiple comorbidities and newly diagnosed AS. OUTCOME MEASURES Two-year clinical and radiographic outcome of a patient treated surgically for multiple spine injuries in the setting of an ankylosed spine. METHODS The patient was treated with a hybrid approach using both open fusion and percutaneous instrumentation techniques. RESULTS At 2 years postoperatively, the patient had recovered ambulatory ability and had a good clinical outcome. CONCLUSIONS We describe a unique case of noncontiguous spinal trauma in a medically complex patient with AS treated with a hybrid open and percutaneous technique to minimize surgical insult and blood loss, with a good clinical and radiographic outcome 2 years postoperatively.
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Affiliation(s)
- Arjun S Sebastian
- The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA
| | - Jeremy L Fogelson
- The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA
| | - Mark B Dekutoski
- The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA
| | - Ahmad N Nassr
- The Department of Orthopedic Surgery, Mayo Clinic, 200 First St, S.W., Rochester, MN 55905, USA.
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