SURGICAL TREATMENT OF CERVICAL SPINE FRACTURES IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Objective. To analyze the results of surgery for cervicothoracic deformity fractures in patients with ankylosing spondylitis.

Material and Methods. Retrospective review of treatment for fractures of cervicothoracic deformity in 6 patients with ankylosing spondylitis was performed. All patients had transdiscal fractures caused by low-energy trauma, most frequently at C5–C6 and C6–C7 levels. Each patient had at least one comorbidity. The spinal cord was injured in 100 % of cases.

Results. Postoperative complications were registered in all patients. Analysis of postoperative x-rays showed that spinal deformity was corrected in most cases, and the stable fixation was achieved at the operated level of the spine. Three patients who had underwent anterior fixation showed the regression of neurological symptoms. Patients classified as Frankel A died of cardiopulmonary insufficiency at 2–7 days after surgery without any signs of neurological symptom regression. Autopsy revealed severe spinal cord injury. Mortality rate was 50 %.

Conclusion. Surgical treatment of cervical spine fractures providing a stable fixation reduces the risk of complications and allows for early activation of patients with ankylosing spondylitis.

1. Ардашев И.П., Гатин В.Р., Ардашева Е.И. и др. Разгибательные переломы шейного отдела позвоночника у больных с болезнью Бехтерева // Настоящее и будущее медицины: М-лы Всерос. науч.-практ. конф. Ленинск-Кузнецкий, 2002. С. 76.

2. Колесов С.В., Сажнев М.Л., Кудряков С.А. и др. Оперативное лечение перелома шейного отдела позвоночника у пациента с болезнью Бехтерева // Хирургия позвоночника. 2011. № 2. С. 8–11.

3. Норкин И.А., Чехонацкий А.А., Нинель В.Г. и др. Лечение перелома шейного отдела позвоночника при болезни Бехтерева // Хирургия позвоночника. 2007. № 2. С. 23–25.

4. Цивьян Я.Л. Оперативное лечение горбов. М., 1973.

5. Belanger TA, Milam RA 4th, Roh JS, et al. Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am. 2005; 87: 1732–1738.

6. Bergmann EW. Fractures of the ankylosed spine. J Bone Joint Surg Am. 1949; 31: 669–671.

7. Bouchard JA, Feibel RJ. Gradual multiplanar cervical osteotomy to correct kyphotic and ankylosing spondylitic deformities. Can J Surg. 2002; 45: 215–218.

8. Broom MJ, Raycroft JF. Complications of fractures of the cervical spine in ankylosing spondylitis. Spine. 1988; 13: 763–766.

9. Campagna R, Pessis E, Feydy A, et al. Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR Am J Roentgenol. 2009; 192: 987–995.

10. Caron T, Bransford R, Nguyen Q, et al. Spine fractures in patients with ankylosing spinal disorders. Spine. 2010; 35: E458–E464.

11. Colterjohn NR, Bednar DA. Identifiable risk factors for secondary neurologic deterioration in the cervical spine-injured patient. Spine. 1995; 20: 2293–2297.

12. Cornefjord M, Alemany M, Olerud C. Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis. Eur Spine J. 2005; 14: 401–408.

13. Einsiedel T, Schemelz A, Arand M, et al. Injuries of the cervical spine in patients with ankylosing spondylitis: experience at two trauma centers. J Neurosurg Spine. 2006; 5: 33–45.

14. Etame AB, Than KD, Wang AC, et al. Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine. 2008; 33: E559–E564.

15. Finkelstein JA, Chapman JR, Mirza S. Occult vertebral fractures in ankylosing spondylitis. Spinal Cord. 1999; 37: 444–447.

16. Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969; 7: 179–192.

17. Graham B, Van Peteghem PK. Fractures of the spine in ankylosing spondylitis. Diagnosis, treatment, and complications. Spine. 1989; 14: 803–807.

18. Graziano GP, Herzenberg JE, Hensinger RN. The halo-Ilizarov distraction cast for correction of cervical deformity. Report of six cases. J Bone Joint Surg Am. 1993; 75: 996–1003.

19. Grisolia A, Bell RL, Peltier LF. Fractures and dislocations of the spine complicating ankylosing spondylitis: a report of six cases. 1967. Clin Orthop Relat Res. 2004; 422: 129–134.

20. Hershman EB, Bercik RJ, Allen SC, et al. Correction of chin-on-chest deformity in ankylosing spondylitis through a fracture site. A case report. Clin Orthop Relat Res. 1985; (201): 201–204.

21. Heyde CE, Fakler JK, Hasenboehler E, et al. Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis. Patient Saf Surg. 2008; 2: 15.

22. Jacobs WB, Fehlings MG. Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance. Neurosurg Focus. 2008; 24: E12.

23. Kanter AS, Wang MY, Mummaneni PV. A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis. Neurosurg Focus. 2008; 24: E11.

24. Khoueir P, Hoh D, Wang M. Use of hinged rods for controlled osteoclastic correction of a fixed cervical kyphotic deformity in ankylosing spondylitis. J Neurosnrg Spine. 2008; 8: 579–583.

25. Langeloo DD, Journee HL, Pavlov PW, et al. Cervical osteotomy in ankylosing spondylitis: evaluation of new developments. Eur Spine J. 2006; 15: 493–500.

26. McMaster MJ. Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br. 1997; 79: 197–203.

27. Mehdian H, Jaffray D, Eisenstein S. Correction of severe cervical kyphosis in ankylosing spondylitis by traction. Spine. 1992; 17: 237–240.

28. Mehdian SM, Freeman BJ, Licina P. Cervical osteotomy for ankylosing spondylitis: an innovative variation on an existing technique Eur Spine J. 1999; 8: 505–509.

29. Meyer PR Jr. Diffuse idiopathic skeletal hyperostosis in the cervical spine. Clin Orthop Relat Res. 1999; (359): 49–57.

30. Mountney J, Murphy AJ, Fowler JL. Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis. Eur Spine J. 2005; 14: 689–693.

31. Rowed DW. Management of cervical spinal cord injury in ankylosing spondylitis: the intervertebral disc as a cause of cord compression. J Neurosurg. 1992; 77: 241–246.

32. Schneider PS, Bouchard J, Moghadam K, et al. Acute cervical fractures in ankylosing spondylitis: an opportunity to correct preexisting deformity. Spine. 2010; 35: E248–E252.

33. Shen FH, Samartzis D. Surgical management of lower cervical spine fracture in ankylosing spondylitis. J Trauma. 2006; 61: 1005–1009.

34. Simmons ED, DiStefano RJ, Zheng Y, et al. Thirty-six years experience of cervical extension osteotomy in ankylosing spondylitis: techniques and outcomes. Spine. 2006; 31: 3006–3012.

35. Simmons EH. Observations on the technique and indications for wedge resection of the spine. J Bone Joint Surg Am. 1968; 50: 847–848.

36. Suk KS, Kim KT, Lee SH, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity in ankylosing spondylitis patients. Spine. 2003; 28: 2001–2005.

37. Thumbikat P, Hariharan RP, Ravichandran G, et al. Spinal cord injury in patients with ankylosing spondylitis: a 10-year review. Spine. 2007; 32: 2989–2995.

38. Urist MR. Osteotomy of the cervical spine: report of a case of ankylosing rheumatoid spondylitis. J Bone Joint Surg Am. 1958; 40: 833–843.

39. Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009; 18: 145–156.

40. Wu CT, Lee ST. Spinal epidural hematoma and ankylosing spondylitis: case report and review of the literature. J Trauma. 1998; 44: 558–561.