scholarly journals Biomechanical influence of the surgical approaches, implant length and density in stabilizing ankylosing spondylitis cervical spine fracture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yaoyao Liu ◽  
Zhong Wang ◽  
Mingyong Liu ◽  
Xiang Yin ◽  
Jiming Liu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Cost Effective ◽  
Element Model ◽  
Surgical Approaches ◽  
Cervical Spine Fracture ◽  
Posterior Fixation ◽  
Pattern Length ◽  
Effective Option ◽  
Cervical Spine Fractures

AbstractAnkylosing spondylitis cervical spine fractures (ASCFs) are particularly unstable and need special consideration when selecting appropriate internal fixation technology. However, there is a lack of related biomechanical studies. This study aimed to investigate the biomechanical influence of the pattern, length, and density of instrumentation for the treatment of ASCF. Posterior, anterior, and various combined fixation approaches were constructed using the finite element model (FEM) to mimic the surgical treatment of ASCFs at C5/6. The rate of motion change (RMC) at the fractured level and the internal stress distribution (ISD) were observed. The results showed that longer segments of fixation and combined fixation approaches provided better stability and lowered the maximal stress. The RMC decreased more significantly when the length increased from 1 to 3 levels (302% decrease under flexion, 134% decrease under extension) than from 3 to 5 levels (22% decrease under flexion, 23% decrease under extension). Longer fixation seems to be more stable with the anterior/posterior approach alone, but 3-level posterior fixation may be the most cost-effective option. It is recommended to perform surgery with combined approaches, which provide the best stability. Long skipped-screwing posterior fixation is an alternative technique for use in ASCF patients.

scholarly journals ANALYSIS OF 111 PATIENTS WITH CERVICAL SPINE FRACTURES IN A TERTIARY HOSPITAL

2016 ◽  
Vol 15 (2) ◽  
pp. 131-133 ◽  
Author(s):  
Hugo Vilchis Sámano ◽  
Edgar Villegas Esquivel ◽  
Luis Muñiz Luna
Keyword(s):  
Cervical Spine ◽  
Tertiary Hospital ◽  
High Energy ◽  
Neurological Involvement ◽  
Common Mechanism ◽  
Cervical Spine Fracture ◽  
Posterior Fixation ◽  
Ao Classification ◽  
Cervical Spine Fractures ◽  
Age Range

ABSTRACT Objective: To describe the epidemiology of 111 patients to determine the age group affected, the level of fracture, fracture classification, and type of treatment. Methods: Descriptive study of 111 cases of cervical spine fracture treated at the Hospital of Traumatology and Orthopedics Lomas Verdes - IMSS from March 2009 to October 2014. Results: The condition appeared in 88% of men. The age range was 16-81 years, with an average of 40 years. The most common fracture according to the AO classification was type A (57%). The segments most affected were C5-C6, C6-C7, C6 and C4-C5 (24.32%, 17.1%, 9.9% and 8.1%). Neurological involvement occurred in 46.8%. The most common mechanism of injury was high energy. Surgical treatment was performed in 78.4% of patients, being one-level corpectomy with placement of mesh and plate, and posterior fixation with facet screws the most appropriate procedures (31.5% and 27.9%, respectively). Conclusions: Males were the most affected, the highest incidence was in C5-C6 and C6-C7 levels and the surgical procedure was the most used.

Surgical treatment of cervical spine fractures in ankylosing spondylitis patients: posterior stabilization using intraoperative CT scanner-based navigation

2020 ◽  
Vol 99 (5) ◽  
pp. 212-218
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Ct Imaging ◽  
Spine Fracture ◽  
Cervical Spine Fracture ◽  
Posterior Stabilization ◽  
Visceral Injury ◽  
Intraoperative Ct ◽  
Screw Insertion ◽  
Spinal Navigation

Introduction: The authors analyzed a series of ankylosing spondylitis patients with cervical spine fracture undergoing posterior stabilization using spinal navigation based on intraoperative CT imaging. The purpose of this study was to evaluate the accuracy and safety of navigated posterior stabilization and to analyze the adequacy of this method for treatment of fractures in ankylosed cervical spine. Methods: Prospectively collected clinical data, together with radiological documentation of a series of 8 consecutive patients with 9 cervical spine fracture were included in the analysis. The evaluation of screw insertion accuracy based on postoperative CT imaging, description of instrumentation- related complications and evaluation of morphological and clinical results were the subjects of interest. Results: Of the 66 implants inserted in all cervical levels and in upper thoracic spine, only 3 screws (4.5%) did not meet the criteria of anatomically correct insertion. Neither screw malposition nor any other intraoperative events were complicated by any neural, vascular or visceral injury. Thus we did not find a reason to change implant position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging in our group of patients was sufficient for reliable trajectory planning and implant insertion in all segments, irrespective of the habitus, positioning method and comorbidities. In addition to stabilization of the fracture, the posterior approach also allows reducing preoperative kyphotic position of the cervical spine. In all patients, we achieved a stable situation with complete bone fusion of the anterior part of the spinal column and lateral masses at one year follow-up. Conclusion: Spinal navigation based on intraoperative CT imaging has proven to be a reliable and safe method of stabilizing cervical spine with ankylosing spondylitis. The strategy of posterior stabilization seems to be a suitable method providing high primary stability and the conditions for a subsequent high fusion rate.

scholarly journals Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

2018 ◽  
Vol 9 ◽  
pp. 215145931877088 ◽  
Author(s):  
Matthew Bank ◽  
Katie Gibbs ◽  
Cristina Sison ◽  
Nawshin Kutub ◽  
Angelos Papatheodorou ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Hospital Mortality ◽  
Spine Fracture ◽  
Cervical Spine Fracture ◽  
Spine Fractures ◽  
Term Survival ◽  
Factors Influencing ◽  
Cervical Spine Fractures ◽  
Long Term Mortality

Objective: To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age. Summary and Background Data: Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly who constitute an increasing percentage of the US population. Methods: We analyzed data collected for 10 years at a state-designated level I trauma center to identify variables that influenced in-hospital and long-term mortality among elderly patients with traumatic cervical spine fracture with or without SCI. Acute in-hospital mortality was determined from hospital records and long-term mortality within the study period (2003-2013) was determined from the National Death Index. Univariate and multivariate regression analyses were used to identify factors influencing survival. Results: Data from patients (N = 632) with cervical spine fractures were analyzed, the majority (66%) of whom were geriatric (older than age 64). Most patients (62%) had a mild/moderate injury severity score (ISS; median, interquartile range: 6, 5). Patients with SCI had significantly longer lengths of stay (14.1 days), days on a ventilator (3.5 days), and higher ISS (14.9) than patients without SCI ( P < .0001 for all). Falls were the leading mechanism of injury for patients older than age 64. Univariate analysis identified that long-term survival decreased significantly for all patients older than age 65 (hazard ratio [HR]: 1.07; P < .0001). Multivariate analysis demonstrated age (HR: 1.08; P < .0001), gender (HR: 1.60; P < .0007), and SCI status (HR: 1.45, P < .02) significantly influenced survival during the study period. Conclusion: This study identified age, gender, and SCI status as significant variables for this study population influencing long-term survival among patients with cervical spine fractures. Our results support the growing notion that cervical spine injuries in geriatric patients with trauma may warrant additional research.

scholarly journals A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E11 ◽  
Author(s):  
Adam S. Kanter ◽  
Michael Y. Wang ◽  
Praveen V. Mummaneni
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Problem Solving ◽  
Surgical Management ◽  
Treatment Algorithm ◽  
Clinical Problem ◽  
Spine Fractures ◽  
Clinical Problem Solving ◽  
Bone Fusion ◽  
Cervical Spine Fractures

Object Patients with ankylosing spondylitis (AS) who present with cervical spine fractures represent a unique challenge to spine surgeons. These injuries often result in neurological deficits that necessitate early and aggressive surgical management with posterior and/or anterior fixation. The authors introduce a clinical problem-solving algorithm to assist in the surgical management of instability and deformity in this exigent patient population. Methods Thirteen patients with AS and fractures of the cervical spine were radiographically evaluated to determine if spinal realignment was obtainable with cervical manipulation or traction. Seven patients had flexible deformities that were stabilized with either anterior or posterior fixation only, and 6 patients had fixed deformities and required circumferential anterior–posterior instrumentation. All patients were observed for neurological outcome, radiographic evidence of bone fusion, and complications. Results With the use of the authors' treatment algorithm, all patients were able to achieve satisfactory spinal realignment and bone fusion; 92% of patients achieved postoperative stability or improvement in Nurick and modified Japanese Orthopaedic Association scale scores. One patient experienced neurological deterioration following surgery, and 1 patient died at an acute rehabilitative facility following discharge. Conclusions Patients with AS are highly susceptible to extensive neurological injury and spinal deformity after sustaining cervical fractures from even minor traumatic forces. These injuries are uniquely complex in nature and require considerable scrutiny and aggressive surgical management to optimize spinal stability and functional outcomes. The authors' clinical problem-solving algorithm will assist spine surgeons in providing optimal care in this difficult population.

scholarly journals Surgical Treatment of Cervical Spine Fracture in a Patient with Ankylosing Spondylitis

2011 ◽  
pp. 8-11
Author(s):  
Sergey Kolesov ◽  
◽  
Maksim Sazhnev ◽  
Stepan Kudryakov ◽  
Aleksandr Prokhorov ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Ankylosing Spondylitis ◽  
Spine Fracture ◽  
Cervical Spine Fracture
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