1/17. Cervical spine injury in patients with ankylosing spondylitis.Fractures of the cervical spine associated with ankylosing spondylitis are rare. Relatively minor injury can cause a fracture of the vertebral body or through the ossified intervertebral space, because of the loss of normal flexibility, mobility, and elasticity in the rigid spine. Sixty-six per cent of the fracture subluxations of the ankylosed spine are associated with injury to the spinal cord, and the mortality rate is 40%. Because of the complete nature of fracture and instability, there is a high risk of neurologic deterioration. immobilization of the cervical spine in a Halo cast appears to be the treatment of choice. If skull traction is applied the cervical spine should be immobilized in the neutral position, and overzealous traction exceeding 10 pounds should be avoided. Callus formation and fracture healing following immobilization is rapid. Four new cases are described and 44 previously reported cases in the literature have been reviewed.- - - - - - - - - - ranking = 1keywords = spondylitis (Clic here for more details about this article) |
2/17. Two-level disruption of the ankylosed spine: a case report.An unusual two-level fracture dislocation of the spine in a patient with rheumatoid spondylitis is presented. Thorough clinical and roentgenographic examination of the entire vertebral column in recommended in patients with rheumatoid spondylitis who have sustained injury.- - - - - - - - - - ranking = 0.4keywords = spondylitis (Clic here for more details about this article) |
3/17. Fractures of the spine in ankylosing spondylitis.Fractures through the disc or the vertebral body as well as the posterior elements are typically seen in ankylosing spondylitis. The fractures can be compared to the fractures of long bones and are often unstable. These fractures are usually associated with increasing pain and may be the result of minor traumas. The radiographic appearance may be discrete, but overlooking the fracture may have disastrous consequences. The characteristic features and the biomechanical pathogenesis of these fractures are reviewed.- - - - - - - - - - ranking = 1keywords = spondylitis (Clic here for more details about this article) |
4/17. Unexplained acute backache in longstanding ankylosing spondylitis.patients with longstanding ankylosing spondylitis who develop untypical severe backache may have spinal lesions.- - - - - - - - - - ranking = 1keywords = spondylitis (Clic here for more details about this article) |
5/17. Complications of fractures of the cervical spine in ankylosing spondylitis.Five patients with ankylosing spondylitis who suffered severe neurologic complications after fracture of the cervical spine are presented. All developed delayed neurologic complications, ranging from 2 to 35 days after the initial injury (mean, 15.8 days). The diagnosis was delayed in four, and in three this delay contributed to morbidity. All fractures occurred in the lower cervical spine (C5 to C7). In three patients, the fracture was the result of minor trauma. A high index of suspicion, an appreciation of the extreme instability of these fractures, and prompt rigid immobilization with a halo vest or case in the alignment of preexisting kyphosis are all important factors in preventing neurologic complications.- - - - - - - - - - ranking = 1keywords = spondylitis (Clic here for more details about this article) |
6/17. Thoracolumbar fractures in ankylosing spondylitis. High-risk injuries.Ankylosing spondylitis may affect the spine segmentally or diffusely. Because all the ligaments become ossified in the involved areas, fractures that occur through this involved segment traverse both bone and ligaments, producing an extremely unstable situation similar to a shearing type of fracture. With a pre-existing severe kyphosis, it may be dangerous to turn the patient to a supine position, because this opens up the fracture and can cause neurologic complications. The radiologic assessment of the spine in ankylosing spondylitis is difficult because the bone is frequently osteoporotic and the disc spaces are poorly outlined. Minor displacements should be looked for, as well as discontinuity of ossified ligaments (especially the interspinous ligaments). Of the seven patients reported in this series, six had fractures undiagnosed at the time of the preliminary examination. Therefore, patients known to have ankylosing spondylitis should be counseled regarding the possibility of a fracture, and if pain persists after an injury, they should be thoroughly investigated radiologically to rule out a potentially serious problem. Reduction of the displacement and stabilization is best achieved with a Luque rectangular rod system, and laminectomy is not indicated.- - - - - - - - - - ranking = 1.4keywords = spondylitis (Clic here for more details about this article) |
7/17. Vertebral osteomyelitis after a closed fracture of the spine. A case report.A case of spinal tuberculosis after a closed fracture, differing from the usual tuberculous spondylitis in that trauma appeared to have predisposed the affected vertebrae to haematogenous infection, is described.- - - - - - - - - - ranking = 0.2keywords = spondylitis (Clic here for more details about this article) |
8/17. Internal fixation for stress fractures of the ankylosed spine.Three cases of stress fractures affecting the rigid spine of ankylosing spondylitis are reported. Even without the typical destructive features of the Romanus lesion, symptoms may be very prolonged and disabling and the diagnosis difficult. Internal fixation produces immediate pain relief and rapid fracture union.- - - - - - - - - - ranking = 0.2keywords = spondylitis (Clic here for more details about this article) |
9/17. spine problems in emergency department patients: does every patient need an x-ray?Two hundred adults with spine problems were evaluated by one examiner in a community hospital emergency department. A patient was considered to have a spine problem requiring evaluation if presenting with pain in the neck or back not obviously caused by a process outside of the spine (eg, back pain in a patient with renal colic); if there was known or suspected trauma to the neck or back; or if the clinical setting suggested spinal tumor, infection, metabolic bone disease, or ankylosing spondylitis. Of the 200 patients, 143 were studied by x-ray films. Six patients (6 of 143, or 4%) had x-ray abnormalities that mandated specific treatment. Fifty-two of the 57 patients not receiving x-ray studies were followed up at 2 months. Thirty-three of these patients (63%) had no x-ray studies in the interim and had improved greatly. Nineteen (37%) had been studied radiographically in the interim, but no abnormality requiring specific treatment was found in any patient. Emergency physicians should be aware that x-ray studies of the spine have low utility for patients whose histories and examinations are benign, that especially for women lumbosacral x-ray studies involve high gonadal radiation exposure, and that selected patients can be managed without x-ray studies and still be satisfied recipients of adequate medical care.- - - - - - - - - - ranking = 0.2keywords = spondylitis (Clic here for more details about this article) |
10/17. Fractures of the thoracolumbar spine in ankylosing spondylitis.Fractures through the disc or juxta-end plate region of the vertebra as well as the posterior elements have been observed in the thoracic and lumbar spine in ankylosing spondylitis. These are usually associated with increasing pain, usually do not produce neurologic deficit, and may require orthopedic fixation to heal. Irregularity and sclerosis at the margins secondary to pseudarthrosis may develop and should not be confused with a pyogenic or granulomatous infection. Biomechanically these fractures resemble the "seat belt type" or Chance fracture probably because of shifting of the axis of flexion and extension in the ankylosed spine away from its normal location in the center of the nucleus pulposus.- - - - - - - - - - ranking = 1keywords = spondylitis (Clic here for more details about this article) |
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