CHARACTERISTIC ASPECTS OF CERVICAL SPINE FRACTURES IN ANKYLOSING SPONDYLITIS – CASE REPORT 143 Experimental Medical Surgical RE SEARCH JOURNAL of Correspondence to: Ana-Maria Maxim, e-mail: [email protected]ABSTRACT: Ankylosing spondylitis is a chronic, systemic, inflamatory disease, that affects especially the axial skeleton. In patients with spondylitis, the cervical segment of the spine is the most affected in trauma. The fracture risk appears even after a minor or mild traumatic event and the rigidity of the spine, the kyphosis, the secondary osteoporosis, have a special contribution. The injuries are localized especially on the lower cervical spine, such as segments C5/C6 and C6/C7 and in the cervico-thoracic junction. Traumatic lesions on ankylosing spondylitis spine are commonly succeeded by spine instability and high risk of secondary neurological deficiency, so that surgical intervention is the most indicated. In this article, we reveal some of the special aspects of the spine fractures in ankylosing spondylitis, illustrating a case of a patient with spondylitis, admitted in the department of traumatology „Casa Austria”, University County Hospital Timisoara, with cervical spine trauma, spinal cord injury and tetraplegia, after a medium intensity traumatic event. Patients with ankylosing spondylitis are highly susceptible to cervical fractures, even after a minor or mild trauma. These lesions often lead to secondary neurological deficits, so that CT or/and MR imaging evaluation of the whole spine is strongly recommended regardless of whether mild initial clinical findings are present. In case of a cervical spine fracture detection, the stabilization procedure is needed, and the standard management includes anterior decompression and combined anterior-posterior stabilization. Anterior approach stabilization alone is not indicated because instability of the posterior column may go undetected in the acute phase of the trauma. Keywords: ankylosing spondylitis, spine fractures, cervical spine trauma. ASPECTE CARACTERISTICE ÎN FRACTURILE COLOANEI CERVICALE DIN SPONDILITA ANCHILOZANTà - PREZENTARE DE CAZ Rezumat:Spondilita anchilopoeticã este o afecþiune sistemicã cronicã ºi o boalã inflamatorie, cu o dezvoltare preponderentã la nivelul scheletului axial. Cel mai frecvent implicat traumatic, la pacienþii cu spondilitã, este segmentul cervical al coloanei vertebrale. Aceºtia sunt supuºi riscului de fracturã, în urma unor traumatisme de intensitate medie sau micã, datoritã cifozei, rigiditãþii ºi osteoporozei existente. Leziunile traumatice sunt localizate cel mai frecvent la nivelul coloanei cervicale distale (C5/C6 ºi C6/C7) ºi la nivelul joncþiunii cervico-toracale. Acestea sunt însoþite foarte frecvent de instabilitate a coloanei vertebrale ºi risc crescut de a dezvolta deficit neurologic, astfel încât, de cele mai multe ori, intervenþia chirurgicalã este o necesitate. În acest articol, exemplificãm particularitatea fracturilor spinale pe fond de spondilitã anchilopoeticã, prezentând cazul unui pacient cu spondilitã, internat în secþia de traumatologie „Casa Austria”, Spitalul Clinic Judeþean de Urgenþã Timiºoara, cu traumatism vertebral cervical mielic ºi tetraplegie. Deoarece aceste leziuni duc de cele mai multe ori la deficit neurologic secundar, evaluarea imagisticã CT ºi RM a întregii coloane este recomandatã, chiar dacã simptomatologia clinicã este minorã. Dacã este prezentã o fracturã cervicalã, este necesarã stabilizarea chirurgicalã a coloanei vertebrale, iar procedura standard este de decompresie ºi apoi, stabilizare combinatã anterioarã ºi posterioarã. Stabilizarea strict anterioarã nu este recomandatã, deoarece o instabilitate a pilonului posterior al coloanei, poate fii de multe ori nedetectatã în fazã acutã. Ana-Maria Maxim 1 , D. Negoescu 2 , Maria Mogoºeanu 1 , Magda Pãscuþ 1 , F. Bîrsãºteanu 1 , D.V. Poenaru 3 Received for publication: 10.03.2009 Revised: 28.04.2009 1.- University of Medicine and Pharmacy „Victor Babeº” Timiºoara, Department of Radiology and Medical Imaging , 2 - Department of Traumatology „Casa Austria”, University County Hospital Timiºoara, 3 - University of Medicine and Pharmacy „Victor Babeº” Timiºoara, Department of Orthopedic Surgery and Traumatology II Journal of Experimental Medical & Surgical Research Cercetãri Experimentale & Medico-Chirurgicale Volume XVI • Issue No.2 •Year 2009 • Pag.143 - 148
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CHARACTERISTIC ASPECTS OF CERVICAL SPINE FRACTURES IN ANKYLOSING SPONDYLITIS
ABSTRACT: Ankylosing spondylitis is a chronic, systemic, inflamatory disease, that affectsespecially the axial skeleton. In patients with spondylitis, the cervical segment of the spine is themost affected in trauma. The fracture risk appears even after a minor or mild traumatic event andthe rigidity of the spine, the kyphosis, the secondary osteoporosis, have a special contribution.The injuries are localized especially on the lower cervical spine, such as segments C5/C6 andC6/C7 and in the cervico-thoracic junction. Traumatic lesions on ankylosing spondylitis spine arecommonly succeeded by spine instability and high risk of secondary neurological deficiency, sothat surgical intervention is the most indicated. In this article, we reveal some of the specialaspects of the spine fractures in ankylosing spondylitis, illustrating a case of a patient withspondylitis, admitted in the department of traumatology „Casa Austria”, University CountyHospital Timisoara, with cervical spine trauma, spinal cord injury and tetraplegia, after a mediumintensity traumatic event. Patients with ankylosing spondylitis are highly susceptible to cervicalfractures, even after a minor or mild trauma. These lesions often lead to secondary neurologicaldeficits, so that CT or/and MR imaging evaluation of the whole spine is strongly recommendedregardless of whether mild initial clinical findings are present. In case of a cervical spine fracturedetection, the stabilization procedure is needed, and the standard management includes anteriordecompression and combined anterior-posterior stabilization. Anterior approach stabilizationalone is not indicated because instability of the posterior column may go undetected in the acutephase of the trauma.Keywords: ankylosing spondylitis, spine fractures, cervical spine trauma.
ASPECTE CARACTERISTICE ÎN FRACTURILE COLOANEI CERVICALE DIN SPONDILITAANCHILOZANTÃ - PREZENTARE DE CAZ
Rezumat:Spondilita anchilopoeticã este o afecþiune sistemicã cronicã ºi o boalã inflamatorie, cuo dezvoltare preponderentã la nivelul scheletului axial. Cel mai frecvent implicat traumatic, lapacienþii cu spondilitã, este segmentul cervical al coloanei vertebrale. Aceºtia sunt supuºi riscului de fracturã, în urma unor traumatisme de intensitate medie sau micã, datoritã cifozei, rigiditãþii ºiosteoporozei existente. Leziunile traumatice sunt localizate cel mai frecvent la nivelul coloaneicervicale distale (C5/C6 ºi C6/C7) ºi la nivelul joncþiunii cervico-toracale. Acestea sunt însoþitefoarte frecvent de instabilitate a coloanei vertebrale ºi risc crescut de a dezvolta deficitneurologic, astfel încât, de cele mai multe ori, intervenþia chirurgicalã este o necesitate. În acestarticol, exemplificãm particularitatea fracturilor spinale pe fond de spondilitã anchilopoeticã,prezentând cazul unui pacient cu spondilitã, internat în secþia de traumatologie „Casa Austria”,Spitalul Clinic Judeþean de Urgenþã Timiºoara, cu traumatism vertebral cervical mielic ºitetraplegie. Deoarece aceste leziuni duc de cele mai multe ori la deficit neurologic secundar,evaluarea imagisticã CT ºi RM a întregii coloane este recomandatã, chiar dacã simptomatologiaclinicã este minorã. Dacã este prezentã o fracturã cervicalã, este necesarã stabilizareachirurgicalã a coloanei vertebrale, iar procedura standard este de decompresie ºi apoi, stabilizare combinatã anterioarã ºi posterioarã. Stabilizarea strict anterioarã nu este recomandatã, deoarece o instabilitate a pilonului posterior al coloanei, poate fii de multe ori nedetectatã în fazã acutã.
Ana-Maria Maxim1,D. Negoescu2, Maria Mogoºeanu1, Magda Pãscuþ1, F. Bîrsãºteanu1, D.V. Poenaru3
Received for publication:
10.03.2009
Revised: 28.04.2009
1.- University of Medicine and Pharmacy „Victor Babeº” Timiºoara, Department of Radiology and Medical Imaging , 2 - Department of Traumatology „Casa Austria”, University County Hospital Timiºoara, 3 - University of Medicine andPharmacy „Victor Babeº” Timiºoara, Department of Orthopedic Surgery and Traumatology II
Journal of Experimental Medical & Surgical Research