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Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2015 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 4, E227-E233 p.Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: 

Prospective cohort study.

OBJECTIVE: 

This study investigates the results of long posterior instrumentation with regard to complications and survival.

SUMMARY OF BACKGROUND DATA: 

Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing.

METHODS: 

Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol.

RESULTS: 

Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury.

CONCLUSION: 

Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4.

Place, publisher, year, edition, pages
2015. Vol. 40, no 4, E227-E233 p.
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-238966DOI: 10.1097/BRS.0000000000000726ISI: 000349767500008PubMedID: 25494322OAI: oai:DiVA.org:uu-238966DiVA: diva2:772896
Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Spinal fractures related to ankylosing spondylitis: Epidemiology, clinical outcome and biomechanics
Open this publication in new window or tab >>Spinal fractures related to ankylosing spondylitis: Epidemiology, clinical outcome and biomechanics
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines.

Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying anti-rheumatic drug (bDMARD) therapy on spinal fractures related to AS.

Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS.

Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved.  It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS.

Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no well-established cadaver models exist.

Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 80 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1277
Keyword
ankylosing spondylitis, spinal fractures
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-307373 (URN)978-91-554-9751-4 (ISBN)
Public defence
2017-01-20, Gullstrandsalen, Akademiska sjukhuset, Ing 70, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2016-12-09 Created: 2016-11-14 Last updated: 2016-12-28

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