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. 2019 Apr 30;13(2):215-220.
doi: 10.14444/6029. eCollection 2019 Apr.

Is Long-Segment Fixation a Rule in Fractures Associated With Ankylosing Spondylitis?

Arvind G Kulkarni  1 , Varun K Agarwal  1 , Nandish Kumar Kc  1 , Avinash Kumar  1 , Ankit Patel  1
Affiliations

Is Long-Segment Fixation a Rule in Fractures Associated With Ankylosing Spondylitis?

Arvind G Kulkarni et al. Int J Spine Surg. .

Abstract

Study design: Technical report.

Objective: We describe the outcomes of percutaneous vertebroplasty in 3-columnar thoraco-lumbar fracture secondary to hyper-extension injury in 3 patients with ankylosing spondylitis (AS). Thoraco-lumbar hyperextension injuries in AS are generally unstable as they involve all 3 spinal columns and traditionally require long-segment posterior instrumented stabilization.

Methods: Three cases of AS with severe medical comorbidities underwent percutaneous vertebroplasty for hyper-extension injury involving all 3 columns. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were documented preoperatively, postoperatively, and at the last follow-up.

Results: Excellent improvements in VAS and ODI scores were achieved. The patients have no complaints and are independent and mobile at 2 years follow-up.

Conclusion: Vertebroplasty is an excellent option in such medically unfit patients with similar diagnosis and should be performed as early as possible before profound instability or neurological insult sets in, which would necessitate bigger and morbid surgeries.

Keywords: 3 column injuries; ankylosing spondylitis, thoraco-lumbar spine fractures; hyper-extension injury; instability; vertebroplasty.

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Conflict of interest statement

Disclosures and COI: There is no conflict of interest among the authors or the institution regarding the manuscript, the scientific work or data collection. The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in our country. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. There was no breach of ethical issues by any of the authors mentioned. The manuscript has been read and approved by the authors and each one of the authors treat their work trust worthy within all ethical parameters.

Figures

Figure 1
Figure 1
Sagittal computed tomography image showing a 3-column fracture of T12 in ankylosing spondylitis (Case 1).
Figure 2
Figure 2
T2 sagittal magnetic resonance imaging showing hyperintense signal adjacent to superior end-plate of T12 vertebra indicating a fracture (Case 1).
Figure 3
Figure 3
(A) Postoperative lateral radiograph of thoracolumbar spine highlighting vertebroplasty at T12 (red arrow; Case 1). (B) Postoperative antero-posterior radiograph of thoracolumbar spine highlighting the vertebroplasty done at T12 (red arrow; Case 1).
Figure 4
Figure 4
Postoperative sagittal computed tomography showing good penetration of cement at the fracture site (Case 2).
Figure 5
Figure 5
Patients mobilized on the same day of vertebroplasty procedure (Cases 1 and 2).
Figure 6
Figure 6
2-year follow-up computed tomography sagittal image (Case 1).
Figure 7
Figure 7
Computed tomography sagittal section showing fracture T12 involving all 3 columns (Case 2).
Figure 8
Figure 8
T2-weighted sagittal magnetic resonance imaging showing pseudoarthrosis (Case 2).
See this image and copyright information in PMC

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