Abstract
PurposeThe purpose of this study was to determine the extent to which magnetic resonance imaging (MRI) performed in patients with ankylosing spondylitis (AS) after low- and no-energy trauma leads to an improved diagnosis and, as a result, to a change in the therapeutic strategy.MethodsAll patients with AS, who underwent surgery after minor traumas (low-energy traumas, LETs) and patients without trauma history (NET: no-energy trauma), were retrospectively analysed. The diagnostic and planned surgical procedure was examined initially and again after total spine MRI in patients with persistent and/or new complaints.ResultsOne hundred and thirty-six patients with AS after trauma were surgically treated. A total of 92 patients with LETs and 12 patients with NETs were included. After initial diagnostics (CT and X-ray) were performed in 15.4% of the patients with LET or NET (n = 16), we found occult fractures on MRI scans. In ten of these patients (6 LET, 4 NET) in which a previous decision was made to follow conservative therapy, no fracture indication was found on CT or X-ray. Two fracture heights were observed in six patients who experienced LET. However, on X-ray and CT, the fractures were only visible at one height. All fractures were treated surgically with stabilization and decompression if indicated.ConclusionConsidering the high percentage of our patient population with occult fractures, we recommend supplementing the basic diagnostic procedures with an MRI of the entire spinal column in patients with painful spinal column findings after minor trauma and for those with persistent pain without trauma.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Ankylosing spondylitis in its severe manifestation is associated with a high risk of vertebral body fractures due to ossification of the ligaments
We analysed whether further surgical procedures were accomplished based on magnetic resonance imaging (MRI) diagnostics, which would not have been performed purely based on radiological diagnostics using thin-layer multidetector computed tomography (CT) (MDCT)
In 92 cases, we found patients with low-energy trauma (LET)
Summary
Ankylosing spondylitis in its severe manifestation is associated with a high risk of vertebral body fractures due to ossification of the ligaments. The fragility of patients with Bechterew’s disease is based on four substantial problems: long lever arm, osteoporosis, sarcopenia, and kyphosis with restriction of the visual axis [2, 10]. The prevalence of vertebral fractures in ankylosing spondylitis is almost 30% with the use of WHO criteria for osteoporosis [5]. Both low bone mineral density and sarcopenia are found in the early stages of Bechterew’s disease [14]. Initially overlooked fractures can lead to pain, secondary dislocations, stenosis, and neurological deficits [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
