Fracture of the lower cervical spine in patients with ankylosing spondylitis: Retrospective study of 19 cases - 29/08/12
, P. Guerin b, C. Schaelderle b, G. Asencio a, O. Gille b
Corresponding author. Tel.: +33 06 03 99 80/04 66 68 31 56.
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Summary |
Introduction |
Controversy exists surrounding optimal treatment of cervical spine fractures secondary to ankylosing spondylitis (AS).
Hypothesis |
The anterior approach is an effective surgical technique for these fractures and can be used to correct the AS-induced cervical-thoracic kyphosis.
Materials and methods |
This continuous, retrospective series between 1990 and 2010 included 19 patients aged 33 to 84 years who presented with a lower cervical spine fracture in the context of AS. The average follow-up was 45 months. Sixteen of these patients were surgically treated using an anterior approach and anterior fixation. In five patients without any neurological deficit, their cervical-thoracic kyphosis was corrected during the same surgery. Regional kyphosis was measured before the surgery, immediately after the surgery and at the last follow-up.
Results |
Five deaths occurred; these were all patients with post-traumatic complete quadriplegia. Most the incomplete neurological problems improved (66%). In no cases did the neurological condition worsen. Among the 16 patients operated with the anterior approach, two patients also required an additional procedure with a posterior approach because of a persistent neurological deficit. The fractures in the operated patients who survived (14 patients) had healed within an average 4-month delay (range 3–7 months), without worsening of the kyphosis at final follow-up. In the five cases where the kyphosis was corrected, the correction averaged 26° (range 18–36°); there were no neurological complications.
Discussion |
Based on these results, we suggest using the anterior approach to perform internal fixation as a treatment for cervical fractures secondary to AS and to correct the cervical-thoracic kyphosis in patients without neurological deficits.
Level of evidence |
Level IV – retrospective study.
Le texte complet de cet article est disponible en PDF.Keywords : Spine, Fracture, Cervical vertebra, Ankylosing spondylitis
Plan
Vol 98 - N° 5
P. 543-551 - septembre 2012 Retour au numéro
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