Abstract
Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.
Highlights
Ankylosing spondylitis is a chronic systemic and inflammatory rheumatic disease with a variable course of the axial skeleton [1]
According to Cornefjord et al [21] fractures of the cervical spine in ankylosing spondylitis are usually diagnosed as hyperextension injuries caused by the spinal deformation when the patient is in the supine position
Anesthesia/Positioning Patients with ankylosing spondylitis are at increased risk for posture deterioration and iatrogenic fractures of the spine during the surgical procedure, especially while under sedation and anesthesia [17,20]
Summary
Ankylosing spondylitis is a chronic systemic and inflammatory rheumatic disease with a variable course of the axial skeleton [1]. If a complete rigidity of the spine is present, i.e. Hehne and Zielke type IIb, III and IIIb (Table 2), there is an increasing risk sustaining such injuries [9,12] In these cases, the rate of neurological complications is extremely high, and special attention must be addressed to delayed or secondary neurological deterioration [3,11,14,15,16]. According to Cornefjord et al [21] fractures of the cervical spine in ankylosing spondylitis are usually diagnosed as hyperextension injuries caused by the spinal deformation when the patient is in the supine position. Anesthesia/Positioning Patients with ankylosing spondylitis are at increased risk for posture deterioration and iatrogenic fractures of the spine during the surgical procedure, especially while under sedation and anesthesia [17,20]. A long instrumentation with a combined dorsoventral 360° fusion is the best option that allows early postoperative mobilization of the patient with ankylosing spondylitis
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