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Surgical stabilisation improves survival of spinal fractures related to ankylosing spondylitis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.ORCID iD: 0000-0002-2724-6372
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 21, 1697-1702 p.Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: National registry cohort studyObjective. To investigate the effect of surgical stabilisation on survival of spinal fractures related to ankylosing spondylitis (AS).

SUMMARY OF BACKGROUND DATA: Spinal fractures related to AS are associated with considerable morbidity and mortality. Multiple studies suggest a beneficial effect of surgical stabilisation in these patients.

METHODS: In the Swedish patient registry all patients treated in an inpatient facility are registered with diagnosis and treatment codes. The Swedish mortality registry collects date and cause of death for all fatalities. Registry extracts of all patients with AS and spinal fractures including date of death and treatment were prepared and analysed for epidemiological purposes.

RESULTS: 17297 individual patients with AS were admitted to treatment facilities in Sweden between 1987 and 2011. 990 patients with AS (age 66±14 years) had 1131 spinal fractures, of which 534 affected cervical, 352 thoracic, and 245 lumbar vertebrae. 13% had multiple levels of injuries during the observed period. Surgically treated patients had a greater survival than those treated non-surgically (HR = 0.79, p = 0.029). Spinal cord injury was the major factor contributing to mortality in this cohort (HR = 1.55, p<0.001). The proportion of surgically treated spinal fractures increased linearly during the last decades (r = 0.92, p<0.001) and was 64% throughout the observed years.

CONCLUSIONS: Spinal cord injury threatened the survival of patients with spinal fractures related to AS. Even though surgical treatment is associated with a considerable complication rate, it improved the survival of spinal fractures related to AS.

Place, publisher, year, edition, pages
2015. Vol. 40, no 21, 1697-1702 p.
Keyword [en]
ankylosing spondylitis; epidemiology; incidence; mortality; national registry; spinal cord injury; spinal fracture; spinal fusion; surgical treatment; survival
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:uu:diva-262361DOI: 10.1097/BRS.0000000000001115ISI: 000369221200018PubMedID: 26267824OAI: oai:DiVA.org:uu-262361DiVA: diva2:853643
Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2017-12-04Bibliographically 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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Robinson, YohanOlerud, Claes

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