1/71. Double spinal cord injury in a patient with ankylosing spondylitis.Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The first injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/71. Clinics in diagnostic imaging (42). Shepherd's fracture.A 21-year-old woman presented with severe ankle pain during a soccer match. Radiographs showed a Shepherd's fracture of the talus. She responded well to conservative treatment. The imaging anatomy of the posterior talus and os trigonum is reviewed, together with radiological features of osteochondritis dissecans of the talar dome.- - - - - - - - - - ranking = 1.6666666666667keywords = fracture (Clic here for more details about this article) |
3/71. Odontoid fracture complicating ankylosing spondylitis.patients with ankylosing spondylitis are prone to fractures. We describe a 32-year-old male patient with an odontoid fracture and anterior dislocation of C1 vertebra relative to C2 complicating ankylosing spondylitis. The importance and difficulties of the rehabilitation program are stressed. The role of magnetic resonance imaging and three-dimensional computerized tomography in diagnosis is emphasized.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
4/71. "Bamboo spine" starts to bend--something is wrong.A typical complication of ankylosing spondylitis with an atypical patient history is reported and the topic is discussed. The diagnosis of a spinal fracture may be difficult in a "bamboo spine".- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
5/71. Opioids in non-cancer pain: a life-time sentence?There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
6/71. A case of osteomalacia mimicking ankylosing spondylitis.A 39-year-old woman presented with symptoms of pain in the lumbar region and lower extremities. Physical findings included restricted movement of the lumbar spine, sacroiliac joint tenderness, positive Schober's test (10-12.5 cm), and bilaterally positive Mennel and Fabere tests. Although these symptoms and findings were suggestive of ankylosing spondylitis, osteomalacia was diagnosed with the appearance of multiple pseudofractures in her pelvic X-ray and laboratory abnormalities. All her symptoms and signs resolved in 6 months with vitamin d and calcium treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
7/71. 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 = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
8/71. A case report of neurologically unstable fracture of the lumbosacral spine in a patient with ankylosing spondylitis.INTRODUCTION: Fracture/dislocation is uncommonly reported in ankylosing spondylitis involving the lumbosacral spine. CLINICAL PICTURE: We report an 18-month follow-up of a case of neurologically unstable traumatic fracture of the lumbosacral spine in ankylosing spondylitis. TREATMENT/OUTCOME: Posterior decompression, alar-transverse fusion and instrumentation were performed. Anterior diskectomy and fusion were done 6 weeks later. There was solid bony fusion on follow-up and the patient had improvement of 2 Frankel grades and was able to ambulate. CONCLUSION: Combined approaches and longer fixations to stabilise the spine may be required. In the lumbosacral spine, this poses a problem vis-a-vis limited levels of fixation in the sacrum.- - - - - - - - - - ranking = 1.6666666666667keywords = fracture (Clic here for more details about this article) |
9/71. Chance type cervical fracture and neurological deficits in ankylosing spondylitis.Prevention of sudden neck movements is vital in patients with ankylosing spondylitis of the cervical spine. We present a case of ankylosing spondylitis who sustained a cervical fracture. He presented with paraplegia after a minor car collision and died of pulmonary embolism after the operation for anterior stabilisation. We believe that the most important matter in a patient with advanced ankylosing spondylitis is the prevention of the fractures and complications. The need for neck protection in automobiles was emphasized and the literature reviewed about the occurrences of neurological deficits following trauma.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
10/71. Complications of halo treatment for cervical spine injuries in patients with ankylosing spondylitis--report of three cases.BACKGROUND: patients suffering from ankylosing spondylitis are prone to injuries of the cervical spine even with minor trauma. Although the fractures are markedly unstable, nonsurgical treatment using a halo-thoracic plaster or jacket is a common approach. methods: We present three patients with cervicothoracic fractures of the ankylosed spine to describe problems and complications inherent in this type of treatment. In two, pin track infections and pin protrusion through the skull occurred, leading in one case to an intracerebral hemorrhage. In the third patient, the halo had to be removed after 8 months, just early enough to prevent the pins from cutting through. RESULTS: One patient required craniotomy. The second one could be resolved by local revision. In the third case, the fracture eventually united after using a stiff collar for 2 years. CONCLUSION: Halo treatment for cervical spine fracture in patients with ankylosing spondylitis is a challenging task for orthopedic surgeons and neurosurgeons.- - - - - - - - - - ranking = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
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