A novel technique for reduction of unreducible lumbar fractures in ankylosing spondylitis

详细信息    查看全文

• 作者：Rajat Mahajan (1) (2)
  Abhishek Srivastava (1)
  Nishit Patel (1)
  Ankur Nanda (1)
  Vijayanth Kanagaraju (1)
  Vikas Tandon (1)
  Harvinder Singh Chhabra (1)
  
• 关键词：Lumbar fracture ; Ankylosing spondylitis ; Lateral position ; Reduction techniques
• 刊名：European Spine Journal
• 出版年：2014
• 出版时间：July 2014
• 年：2014
• 卷：23
• 期：7
• 页码：1568-1572
• 全文大小：1,435 KB
• 参考文献：1. Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145-56 CrossRef
  2. Lv GH et al (2009) Combined anterior and posterior surgery for treatment of cervical fracture dislocation in patients with ankylosing spondylitis. Chin J Traumatol 12(3):148-52
  3. Kanathur N, Lee-Chiong T (2010) Pulmonary manifestations of ankylosing spondylitis. Clin ChestMed 31(3):547-54 CrossRef
  4. Jacobs WB, Fehlings MG (2008) Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance. Neurosurg Focus 24:E12 CrossRef
  5. Vosse D et al (2009) Ankylosing spondylitis and the risk of fracture: results from a large primary care based nested case–control study. Ann Rheum Dis 68:1839-842 CrossRef
  6. Caron T et al (2010) Spine fractures in patients with ankylosing spinal disorders. Spine 35(11):E458–E464
  7. Grisolia A, Bell RL, Peltier LF (2004) Fractures and dislocations of the spine complicating ankylosing spondylitis: a report of six cases 1967. Clin Orthop Relat Res 422:129-34 CrossRef
  8. Guo ZQ et al (2004) Treatment of spinal fractures complicating ankylosing spondylitis. Zhonghua Wai Ke Za Zhi 42(6):334-39
  9. Jain AK et al (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 90(11):1477-481 CrossRef
  10. Jain AK, Dhammi IK, Jain S et al (2010) Kyphosis in spinal tuberculosis—prevention and correction. Indian J Orthop 44(2):127-36 CrossRef
  11. Chang KW et al (2006) Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine 31(13):E408–E413 CrossRef
  12. Zhang WS et al (2013) Operative strategy for different types of thoracolumbar stress fractures in ankylosing spondylitis. J Spinal Disord Tech [Epub ahead of print]
  13. Altenbernd J, Bitu S, Lemburg S et al (2009) Vertebral fractures in patients with ankylosing spondylitis: a retrospective analysis of 66 patients. Rofo 181(1):45-3 CrossRef
  14. Sapkas G, Kateros K, Papadakis SA et al (2009) Surgical outcome after spinal fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord 10:96 CrossRef
  
• 作者单位：Rajat Mahajan (1) (2)
  Abhishek Srivastava (1)
  Nishit Patel (1)
  Ankur Nanda (1)
  Vijayanth Kanagaraju (1)
  Vikas Tandon (1)
  Harvinder Singh Chhabra (1)
  
  1. Indian Spinal Injuries Centre, Block C 3, Vasant Kunj, New Delhi, India
  2. B 22 Brahma Apartments, Sector 7, Plot 7, Dwarka, New Delhi, 110075, India
  
• ISSN：1432-0932

文摘

Study design Retrospective case series study. Purpose of study Fractures in ankylosed lumbar spine are difficult to reduce and it is like attempting to reduce the ends of a long bone fracture of an extremity. Simple compression from the posterior results in the anterior column opening in lumbar spine because of the inherent lordosis present there, which usually requires combined approach, if the gap is extensive. Purpose of our study is to describe a new technique for reduction of lumbar fracture not reducing through conventional technique in ankylosing spondylitis. There are no techniques described for reduction of these complex fractures in the literature to the best of our knowledge. Methods Four patients were operated by a new modified staged posterior approach. Two patients had AIS D neurology, one patient had AIS A neurology and one patient had normal neurology (AIS E). Patients were operated in a staged procedure in a single sitting, as single posterior procedure did not allow for complete reduction of lumbar fracture. The patients were first positioned prone and instrumentation was done. To close the anterior gap, patients were then positioned lateral and reduction and stabilization of fracture was done. Results Mean age of the patients was 50?years. Average time of surgery was 3?h 40?min. All four patients operated with this modified posterior approach had fusion 6?months after surgery. There were no significant complications. Conclusion We recommend this technique to be used in fractures in lumbar ankylosed spine as they have tendency to open anteriorly after trauma. It helps in closure of anterior column in a single surgery and obviates the need for anterior surgery in these patients.