[Diagnosis and treatment of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis].

OBJECTIVE

To discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis (AS).

METHODS

Thirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009, including 11 males and 2 females,aged varied from 33 to 60 years (mean 46) in 11 males and from 36 to 59 years (mean 47.5) in 2 females respectively. The symptom duration of AS was from 12 to 27 years (means 14.5 years). The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed.

RESULT: A total of 13 patients, who underwent operation, were followed up for 12 to 43 months(means 35.6 months). There were 6 patients were treated with anterior cervical discectomy and fusion, 4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 cases during perioperation.

CONCLUSION

This study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unstable and require operations. If operative method is proper and operative process accurate, either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.