Backbone Fractures in Ankylosing Ailments: Suggestions of the Backbone Part of the German Society for Orthopaedics and Trauma (DGOU).
World Backbone J. 2018 Sep;eight(2 Suppl):56S-68S
Authors: Reinhold M, Knop C, Kneitz C, Disch A
Examine Design: Overview of literature and case sequence.
Targets: Replace and assessment of present remedy ideas for backbone fractures in sufferers with ankylosing spinal issues.
Strategies: Case presentation and outline of a diagnostic and therapeutic algorithm for unstable spinal accidents with an underlying ankylosing spinal dysfunction (ASD) of the cervical and thoracolumbar backbone.
Outcomes: Nondisplaced fractures could be missed simply utilizing standard X-rays. Thus, computed tomography (CT) scans are really helpful for all trauma sufferers with ASD. Unsure or presence of any neurologic involvement further magnetic resonance imaging (MRI) scans needs to be obtained. Backbone precautions needs to be maintained all occasions and till definitive remedy (<24 h). Nonoperative fracture remedy isn’t really helpful given the mechanical instability of essentially the most generally seen fracture patterns (AOSpine B- and C-type, M2) in sufferers with ASD and inherent excessive threat of secondary neurologic deterioration. For sufferers with ankylosing spondylitis (AS) or diffuse idiopathic hyperostosis (DISH) sustaining cervical backbone fractures, a mixed anterior-posterior instrumentation for fracture fixation is really helpful. Closed discount and affected person positioning could be difficult in presence of preexisting kyphotic deformities. Within the thoracolumbar (TL) backbone, a posterior instrumentation extending 2 to three ranges above and under the fracture stage is really helpful to keep up satisfactory discount and stability till fracture therapeutic. Minimally invasive percutaneous pedicle screws and cement augmentation may also help to reduce the surgical trauma and strengthen the assemble stability in sufferers with diminished minor bone high quality (osteopenia, osteoporosis).
Conclusions: Present ideas, remedy choices, and suggestions of the German Orthopedic Trauma Society-Backbone Part for spinal fractures within the ankylosed backbone have been outlined.
PMID: 30210963 [PubMed]