Spontaneous Spine Fracture in Patient with Ankylosing Spondylitis under Spinal Anesthesia: A Case Report and Review of the Literature

Factures in ankylosing spondylitis (AS) patients tend to occur due to the absence of motion between vertebrae, poor bone quality, and a long lever arm that generates extension force. However, most patients have a history of at least minor trauma. The aim of this report was that a vertebral fracture in a patient with AS can be caused not only by minor trauma, but also by position changes or maintenance of position for examination due to structural weakness. A 75-year-old woman with AS visited her local hospital on foot for back pain. She usually had back pain. However, she had increased back pain after falling over three weeks prior. In plain radiographs, no fracture was apparent. The doctor tried to perform magnetic resonance imaging (MRI) for further evaluation. However, several attempts of MRI failed due to continuous movement arising from pain. As a result, MRI was performed under spinal anesthesia for pain control. However, complete paraplegia developed during the MRI examination. MRI showed extension-type vertebral fracture with displacement and the patient was transferred to our hospital. We performed emergency posterior fusion, but neurological symptoms did not improve. This case suggests the need for careful positioning, sedation, or anesthesia when performing an examination or surgery in AS patients. We recommend that all patients with AS should be carefully positioned at all times during testing or surgery.

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Just the Facts: Risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department

CJEM ◽

10.1017/cem.2020.422 ◽

2020 ◽

Vol 22 (6) ◽

pp. 753-755

Author(s):

Zoe Polsky ◽

Shawn K. Dowling ◽

W. Bradley Jacobs

Keyword(s):

Emergency Department ◽

Back Pain ◽

Epidural Abscess ◽

Spinal Epidural Abscess ◽

Thoracic Spinal ◽

Life Threatening ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Whole Spine ◽

Spinal Epidural

A 65-year-old male with a history of hypertension presents to the emergency department (ED) with new onset of non-traumatic back pain. The patient is investigated for life-threatening diagnoses and screened for “red flag symptoms,” including fever, neurologic abnormalities, bowel/bladder symptoms, and a history of injectiondrug use (IVDU). The patient is treated symptomatically and discharged home but represents to the ED three additional times, each time with new and progressive symptoms. At the time of admission, he is unable to ambulate, has perineal anesthesia, and 500 cc of urinary retention. Whole spine magnetic resonance imaging (MRI) confirms a thoracic spinal epidural abscess. This case, and many like it, prompts the questions: when should emergency physicians consider the diagnosis of a spinal epidural abscess, and what is the appropriate evaluation of these patients in the ED? (Figure 1).

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MRI Detection of Active Sacroiliitis in First Degree Relatives of Ankylosing Spondylitis Patients with Clinical and Laboratory Correlations

10.21203/rs.3.rs-560548/v1 ◽

2021 ◽

Author(s):

Haron Obaid ◽

Stephan Milosavljevic ◽

Udoka Okpalauwaekwe ◽

Brenna Bath ◽

Catherine Trask ◽

...

Keyword(s):

Back Pain ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Hla B27 ◽

Physical Test ◽

First Degree Relatives ◽

Pain Provocation ◽

History Of ◽

Active Sacroiliitis

Abstract Background. Detection of ankylosing spondylitis (AS) in the preclinical stage could help prevent long term morbidity in this patients’ population. The aim of this study was to examine the prevalence of active sacroiliitis in first-degree relatives of AS patients using MRI with clinical and laboratory correlations as these patients may benefit from MRI screening and early treatment.Methods. Seventeen first-degree relatives of AS patients were recruited prospectively. AS screening questionnaires (Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index & Visual Analogue Scale), blood tests (C-Reactive Protein, HLA-B27), and an MRI of the SIJs were taken. Two musculoskeletal radiologists interpreted the MRI scans, and two physiotherapists applied four symptom provocation tests (Gaenslen's test, posterior pelvic pain provocation test, Patrick's Faber (PF) test and palpation of the long dorsal SIJ ligament test), and two functional movement tests (active straight leg raise and Stork test). Results. Seven (41%) of the 17 participants demonstrated MRI evidence of active sacroiliitis. Of the 7 participants with active sacroiliitis, two (29%) had no history of recent low back pain (LBP), two (29%) had negative HLA-B27, and one (14%) participant had neither back pain nor positive HLA-B27. The Cohen's Kappa score for the interobserver agreement between the radiologists was 1.00 (p-value <0.0001). Despite fair to strong between therapist agreement for the physical test outcomes (Kappa 0.26 to 1.00), the physical test results per se did not have any predictive association with a positive MRI.Conclusions. MRI detected active sacroiliitis in 41% of first-degree relatives of AS patients. The lack of a history of prior LBP or positive HLA-B27 in active sacroiliitis participants might suggest that MRI screening for this high-risk population is warranted; however, further larger studies are needed to help elucidate its cost-effectiveness and long-term benefits.

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Ankylosing spondylitis, other spondyloarthritides, and related conditions

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.1906 ◽

2010 ◽

pp. 3603-3616 ◽

Cited By ~ 1

Author(s):

J. Braun ◽

J. Sieper

Keyword(s):

Rheumatoid Arthritis ◽

Back Pain ◽

Ankylosing Spondylitis ◽

Gastrointestinal Tract ◽

Rheumatic Diseases ◽

Skin Lesions ◽

Inflammatory Back Pain ◽

Psoriatic Skin ◽

Inflammatory Rheumatic Diseases ◽

History Of

The spondyloarthritides are a group of inflammatory rheumatic diseases with predominant involvement of axial and peripheral joints and entheses, together with other characteristic clinical features, including inflammatory back pain, sacroiliitis, peripheral arthritis (mainly in the legs), enthesitis, dactylitis, preceding infection of the urogenital/gastrointestinal tract, psoriatic skin lesions, Crohn-like gut lesions, anterior uveitis, and a family history of Spondyloarthritis. They are the second most frequent inflammatory rheumatic diseases after rheumatoid arthritis....

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The epidemiology of ankylosing spondylitis, axial spondyloarthritis, and back pain

10.1093/med/9780198755296.003.0003 ◽

2016 ◽

Author(s):

Stefan Siebert ◽

Sengupta Raj ◽

Alexander Tsoukas

Keyword(s):

Back Pain ◽

Ankylosing Spondylitis ◽

Axial Spondyloarthritis ◽

Epidemiological Studies ◽

Population Based ◽

Inflammatory Back Pain ◽

True Incidence ◽

Primary Care Population ◽

Prevalence Estimates ◽

History Of

Low back pain is a leading cause of disability worldwide. The prevalence of inflammatory back pain (IBP) has been calculated to be in the range 8–15% in a UK primary care population and 5–7% in a US population-based cohort. IBP rates are significantly higher in patients with psoriasis, uveitis, or inflammatory bowel disease than the general population. There is a paucity of good epidemiological studies to define the true incidence and prevalence of ankylosing spondylitis (AS), axial spondyloarthritis (axSpA), and spondyloarthritis (SpA), with wide variation as a result of geographic, demographic and methodological factors. The global prevalence estimates range from 0.01–0.2% for AS, to 0.32–0.7% for axSpA and around 1% for SpA overall. The global incidence estimates range from 0.44–7.3 cases per 100,000 person-years for AS to 0.48–62.5 cases per 100,000 person-years in SpA. The demographics and natural history of disease progression are also discussed.

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Discovertebral Erosions in Patients with Enteropathic Spondyloarthritis

The Journal of Rheumatology ◽

10.3899/jrheum.120415 ◽

2012 ◽

Vol 39 (12) ◽

pp. 2332-2340 ◽

Cited By ~ 7

Author(s):

ROSARIO PELUSO ◽

MATTEO NICOLA DARIO DI MINNO ◽

VINCENZO BRUNER ◽

ERNESTO SOSCIA ◽

FABIANA CASTIGLIONE ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Bacterial Infections ◽

Activity Index ◽

Disease Activity Index ◽

High Prevalence ◽

History Of ◽

Peripheral Type ◽

Inflammatory Bowel ◽

Magnetic Resonance Imaging Mri ◽

Type 3

Objective.Magnetic resonance imaging (MRI) is considered the modality of choice for the diagnosis of spondyloarthropathy (SpA)-related spondylodiscitis, or discovertebral erosions (DE). Our aim was to analyze the prevalence and the clinical features of DE in patients with enteropathic SpA (EA) using MRI.Methods.We evaluated 72 patients with EA and 43 controls for the study. All patients and controls underwent rheumatological and gastroenterological clinical examinations, and demographic features were recorded. For each patient, these factors were also recorded: duration of inflammatory bowel disease and arthritis from onset to enrollment, history of viral and bacterial infections, and occurrence of previous major trauma to the spine. These scores were taken: Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Harvey-Bradshaw Index, and the Simple Clinical Colitis Activity Index. All subjects had MRI of the spine.Results.On the basis of inclusion criteria, 43 patients with EA were included in the study. Twenty-three had axial EA (axEA) and 20 had axial and peripheral subset EA (overlap subset or peripheral type 3; axphEA). Twenty-two patients with EA (15/7 axEA/axphEA) showed DE (30.55%; p < 0.001). DE was significantly more prevalent in axEA subjects than in the overlap subset (p < 0.001). In axEA, DE had a significant direct correlation with arthritis duration (r = 0.546, p = 0.007). Patients with DE showed BASDAI, BASMI, and BASFI scores significantly higher than patients without DE (p < 0.001).Conclusion.We found a high prevalence of DE among patients with EA (30.55%), confirming that DE is an important characteristic aspect of SpA. We found a high prevalence in patients in the axphEA subset (31.82%), suggesting that DE could be a characterizing feature of the overlap subset.

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P51 Is it injury or inflammation: teenage boy with back pain

Rheumatology ◽

10.1093/rheumatology/kez416.018 ◽

2019 ◽

Vol 58 (Supplement_4) ◽

Author(s):

Samundeeswari Deepak ◽

Tracey Dandy ◽

Rachel Isles

Keyword(s):

Back Pain ◽

Ankylosing Spondylitis ◽

Conflicts Of Interest ◽

Lower Limbs ◽

Creatinine Kinase ◽

Foot Drop ◽

Full Blood Count ◽

Long Thoracic Nerve ◽

History Of ◽

The Right

Abstract Background A 14 year-old boy was referred by an orthopaedic colleague at the district hospital for evaluation of ankylosing spondylitis. The child was previously fit and well. His symptoms reported at the referral was back pain and also possibility of foot drop on the right ankle. His dad had ankylosing spondylitis and was on biologic treatment. Also, there was significant history of autoimmunity in other family members. Methods During the initial consultation, we revisited the history. The boy reported that main symptoms were recurrent popping sensation of his right side shoulder associated with pain and burning sensation on the shoulder which usually settles after an hour. He is sporty boy and plays regular rugby, football and used to throw discus. He denied any history of injury or illnesses preceding his symptoms. There was past history of fracture of right ankle on two occasions managed conservatively. There were no other systemic symptoms. On examination, the child was afebrile and systemically looked well. There was no lymphadenopathy, mouth ulcers or clubbing. His cardio respiratory examination was normal. Abdomen was soft with no organomegaly. He was noted to have winging of scapula on the right side and weakness of the abductor muscles on the right side shoulder. There was wasting of muscles around the right ankle. He was noticed to have bilateral cavovarus and high arched feet. There was scoliosis at the thoracic and lumbar level. His muscle tone, power and reflexes were all normal. Results With his clinical presentation of winging of scapula, long thoracic nerve palsy was considered and he was referred to local physiotherapy. MRI spine done at local hospital was reviewed in the MSK radiology meeting and this showed no evidence of ankylosing spondylitis and confirmed scoliosis. His blood tests showed normal full blood count, liver and kidney function, raised creatinine kinase of 358 and HLA B27 positive. The repeat creatinine kinase was normal (153).The nerve conduction study of both the upper and lower limbs were normal. He was also seen by the neurology team. Further discussion with sport medicine colleagues and advised to continue physiotherapy. On the review 3 months later, his symptoms were much improved. Conclusion The presentation of a teenage boy with back pain and family history of ankylosing spondylitis warrants further evaluation. Thorough history, examination and early referral to specialist centre is beneficial for appropriate management of complex situations like this. Conflicts of Interest The authors declare no conflicts of interest.

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Acute Transverse Myelopathy in Children

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100030006 ◽

1990 ◽

Vol 17 (1) ◽

pp. 40-45 ◽

Cited By ~ 4

Author(s):

Coleen Adams ◽

Derek Armstrong

Keyword(s):

Spinal Cord ◽

Clinical Signs ◽

Sensory Level ◽

Initial Symptom ◽

Minor Trauma ◽

Resonance Imaging ◽

Prognostic Features ◽

Transverse Myelopathy ◽

History Of ◽

Magnetic Resonance Imaging Mri

ABSTRACT:Twenty-three children with acute transverse myelopathy (ATM) are reviewed. Antecedent minor trauma or exercise was reported in 10 patients. Despite a positive history in 7 patients no preceding infection was documented. Two patients had a history of less severe ATM followed by recovery prior to a second more severe episode. The most common initial symptom was back pain and the most prominent clinical signs were weakness, sensory level and sphincter disturbances. Myelography and CT myelography at presentation was performed to exclude a compressive lesion. Spinal cord enlargement was demonstrated in 6 of 21 cases. Magnetic resonance imaging (MRI) of the spinal cord, performed in one patient, showed enlargement of the cord. Poor prognostic features were severity of weakness at the time of maximum deficit and a delayed onset of recovery. Maximum motor recovery occurred at a mean of 6½ months but did not occur in one patient until 1½ years. Normal or good outcome was obtained in 64%.

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An Investigation of the Relationship between Anthropometry (Height, Weight, and Body Mass Index) and Incidence of Low Back Pain Following Spinal Anesthesia in Elective and Emergency Surgical Procedures

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v6i4.4633 ◽

2020 ◽

Author(s):

Reza Gharedaghi ◽

Mastaneh Rajabian Tabesh ◽

Farsad Imani ◽

Maryam Abolhasani

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Spinal Anesthesia ◽

Exact Nature ◽

Muscular Tissue ◽

Low Back ◽

History Of ◽

The Mean ◽

The Relationship

Background: The incidence of low back pain in adults after spinal anesthesia is rather similar to that of general anesthesia. The pain is often mild with an increased incidence of low back pain that rarely spreads to the lower extremities but persists for several days after surgery. Fear of complications of back pain after neuraxial injection is one the main reason for patient’s refusal of neuraxial anesthesia. Some studies repoted obesity and BMI above 32 as risk factors for low back pain after surgery. In this study, we aimed to investigate the relationship between selected parameters of body composition, including the amount of total body fat and muscular tissue, and the incidence of low back pain after spinal anesthesia. Methods: A cross-sectional study was carried out on 100 patients who were candidates for elective or emergency surgery under spinal anesthesia. At first demographic data, a history of back pain and assessment and anthropometric assessment was asked. The history of back pain and intensity of pain were asked after one day, one month and 4 months after surgery. Then the relationship between pain intensity and anthropometric data were assessed. Results: The mean pain intensity in the normal weight group was 1.3 ± 0.63. In the overweight group, the mean pain intensity was 1.1 ± 0.41. In the obese group, the mean pain intensity was 2.2± 1.2. Regarding the relationship between mean pain intensity and weight, BMI, and anthropometry, the incidence of pain was not related to patients' anthropometry; the mean pain intensity of these groups were compared; and the incidence of pain was not dependent on weight, BMI, and anthropometry (p-value= 0.4). Conclusion: Based on the obtained results, it can be concluded that no correlation exists between the incidence of low back pain and mean severity of pain and anthropometric indicators such as BMI, however, low back pain lasted longer in obese patients, which requires further study to investigate the exact nature of such a relationship.

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REASONS FOR DIAGNOSTIC DELAYS OF AXIAL SPONDYLOARTHRITIS

Wiadomości Lekarskie ◽

10.36740/wlek201909102 ◽

2019 ◽

Vol 72 (9) ◽

pp. 1607-1610

Author(s):

Robert Zwolak ◽

Dorota Suszek ◽

Aleksandra Graca ◽

Marcin Mazurek ◽

Maria Majdan

Keyword(s):

Back Pain ◽

Ankylosing Spondylitis ◽

Axial Spondyloarthritis ◽

Diagnostic Delay ◽

Connective Tissue Diseases ◽

Inflammatory Back Pain ◽

Hla B27 ◽

History Of ◽

Axial Symptoms ◽

Diagnostic Delays

Introduction: The probability of development of axial spondyloarthritis (axSpA) is estimated to be above 90% among patients with chronic back pain, presence of HLA B27 antigen and positive family history of ankylosing spondylitis (AS), psoriasis, reactive arthritis, inflammatory bowel disease or uveitis. The nonradiographic axSpA and ankylosing spondylitis diseases’ activity has a comparable impact on the patients’ quality of life and from the practical point of view the approach to treatment of each of them is the same. The aim: The attempt to identify the reasons of diagnostic delays of AS among patients hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin and to suggest the ways of improving the accuracy of diagnostic track among other healthcare providers than rheumatologists. Material and methods: We performed a retrospective analysis of the records of 82 patients’ with the established diagnosis of AS, hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin in 2000-2019, and of 45 years of age and older. Results: From among 82 patients (28 women and 54 men) the diagnosis of AS after 45 years of age was established in 25 patients (10 women and 15 men) – group t, and in the other 57 patients (group n) the diagnosis was established before 45 years of age. On average the age at the time of diagnosis in the whole group (t+n) was 40,7±10,2 (18-76) years, the age at the beginning of inflammatory back pain (age of axial symptoms) was 30,9±8,5 (13-51) years and the diagnostic delay (period between first axial symptoms and diagnosis establishment) was 9,75±9,5 (0-46) years. We did not find any statistically significant associations between sex and age at the moment of diagnosis, age of the beginning of axial symptoms and the time of diagnostic delay. There was no significant difference of incidence of enthesitis, uveitis, arthritis, prevalence of family history of spondyloarthritis and CRP level between group t and n. Antigen HLA B27 was more frequently present in group t. Conclusions: Instead of the recognition progress and worldwide popularization of knowledge about axSpA, the diagnostic delays in this field are still estimated to last many years, the patients are looking for other specialists’ help, and they can be not knowledgeable of the inflammatory back pain criteria. Currently, HLA B27 antigen and C-reactive protein are the two most commonly used biomarkers for diagnostic and disease activity monitoring purposes of axSpA and magnetic resonance is the only “imaging biomarker” The presence of extra-axial symptoms does not improve the diagnostic sensitivity.

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Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03642-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Liang Dong ◽

Chunke Dong ◽

Yuting Zhu ◽

Hongyu Wei

Keyword(s):

Back Pain ◽

Vertebral Fracture ◽

Benign Lesion ◽

Spinal Tuberculosis ◽

Compression Fracture ◽

Lower Limbs ◽

Vertebral Compression Fractures ◽

Minor Trauma ◽

Ct Guided ◽

Intravertebral Cleft

Abstract Background Among common findings in osteoporotic vertebral compression fractures (OVCFs), the intravertebral cleft (IVC) is usually considered a benign lesion. The current study was aimed to present a rare case of vertebral fracture caused by IVC-related spinal tuberculosis. Case presentation A 73-year-old female complained of back pain and weakness in lower limbs for 2 weeks. 3 months ago, after a minor trauma, she got back pain without weakness in lower limbs. Initially, she was diagnosed with a L1 compression fracture and accepted conservative treatment. After an asymptomatic period, she complained progressive pain at the fracture position with weakness of both lower limbs and was referred to our hospital with suspicion of Kümmell’s disease. The patient underwent posterior debridement and internal fixation for decompression and stabilization of the spine. Pathological examinations revealed the patient with spinal tuberculosis. Conclusions Although IVC is common in patients with OCVFs, there are some cases believed to be found in patients with spinal tuberculosis or infection. Further test, like CT-guided puncture biopsy, may be required before decisive treatment when an IVC is observed.

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