EC Orthopaedics

In patients with ankylosing spondylitis (AS) even a low impact trauma can lead to a significant injury. A case study of an 86-year-old man illustrates the complexity in diagnosis and treatment following a fall that resulted into a thoracic spine fracture. Initial investigations revealed critical injuries, resulting in surgical intervention. The management of such injuries is complicated by high rates of comorbidities and potential postoperative complications, including respiratory failure and cardiac issues. As such, the priority is on the detection of the injury as it may be flawed by the lack of identifying it sufficiently as much as a timely surgical intervention to improve outcomes and reduce mortality rates associated with these conditions. Overall, early recognition and comprehensive management are crucial for enhancing patient survival and quality of life.

 Keywords: Ankylosing Spinal Diseases; AO Spine Classification; Ankylosing Spondylitis (AS)

1. Angelopoulou F., et al. “DISH vs spondyloarthritides”. Mediterranean Journal of Rheumatology 1 (2020): 81-83.
2. Yunoki M., et al. “Importance of recognizing diffuse idiopathic skeletal hyperostosis for neurosurgeons: a review”. Neurologia Medico-Chirurgica (Tokyo)8 (2016): 510-515.
3. Khedr EM., et al. “Neurological complications of ankylosing spondylitis: neurophysiological assessment”. Rheumatology International 9 (2009): 1031-1040.
4. Mundwiler ML., et al. “Complications of the spine in ankylosing spondylitis with a focus on deformity correction”. Neurosurgery Focus1 (2008): E6.
5. Willems KF., et al. “Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year”. Spine (Phila Pa 1976) 1 (2005): 101-107.
6. Westerveld LA., et al. “Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients”. The Spine Journal 5 (2014): 729-740.
7. Braun J., et al. “Fifty years after the discovery of the association of HLA B27 with ankylosing spondylitis”. RMD Open3 (2023): e003102.
8. Danve A., et al. “Axial spondyloarthritis (Including ankylosing spondylitis)”. EBSCO Information Services (2024).
9. Ciaffi J., et al. “Prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in Italy”. La Radiologia Medica 10 (2022): 1159-1169.
10. Gökşenoğlu G., et al. “The prevalence of comorbidity and predictors in ankylosing spondylitis”. Turkish Journal of Physical Medicine and Rehabilitation 2 (2018): 132-138.
11. Bhattad PB., et al. “Cardiovascular morbidity in ankylosing spondylitis: a focus on inflammatory cardiac disease”. Cureus6 (2022): e25633.
12. Donnelly S., et al. “Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis”. Annals of the Rheumatic Diseases 2 (1994): 117-121.
13. Einsiedel T., et al. “Injuries of the cervical spine in patients with ankylosing spondylitis: experience at two trauma centers”. Journal of Neurosurgery: Spine 1 (2006): 33-45.
14. Westerveld LA., et al. “Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications”. European Spine Journal 2 (2009): 145-156.
15. Harlianto NI., et al. “The prevalence of vertebral fractures in diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: A systematic review and meta-analysis”. North American Spine Society Journal 17 (2024): 100312.
16. Tu PH., et al. “Spinal cord injury and spinal fracture in patients with ankylosing spondylitis”. BMC Emergency Medicine1 (2022): 73.
17. Finkelstein JA., et al. “Occult vertebral fractures in ankylosing spondylitis”. Spinal Cord6 (1999): 444-447.
18. Schiefer TK., et al. “In-hospital neurologic deterioration following fractures of the ankylosed spine: a single- institution experience”. World Neurosurgery 5 (2015): 775-783.
19. Teunissen FR., et al. “Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders”. Journal of Neurosurgery: Spine 6 (2017): 709-716.
20. Tan T., et al. “Patients with ankylosing spondylitis suffering from AO Type B3 traumatic thoracolumbar fractures are associated with increased frailty and morbidity when compared with patients with diffuse idiopathic skeletal hyperostosis”. Journal of Spine Surgery 4 (2019): 425-432.
21. Caron T., et al. “Spine fractures in patients with ankylosing spinal disorders”. Spine (Phila Pa 1976)11 (2010): E458-E464.
22. Schoenfeld A J., et al. “Mortality in elderly patients with hyperostotic disease of the cervical spine after fracture: an age- and sex-matched study". The Spine Journal 4 (2011): 257-264.
23. Barkay G., et al. “Early surgery for thoracolumbar extension-type fractures in geriatric patients with ankylosing disorders reduces patient complications and mortality”. The Spine Journal 1 (2023): 157-162.
24. Harlianto N., et al. “Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review”. The Spine Journal 9 (2022): 1490-1503.
25. Braun J., et al. “Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors”. Arthritis and Rheumatology 1 (1998): 58-67.
26. Mathieu S., et al. “Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis”. Arthritis Care and Research (Hoboken)4 (2011): 557-563.
27. Vaccaro AR., et al. “AOspine thoracolumbar spine injury classification system”. Spine 23 (2013): 2028-2037.