Sat., 10/20/07 Pediatrics/Spine, Paper #66, 3:59 pm OTA-2007
Treatment and Outcomes of Patients with Ankylosing Spondylitis and Diffuse
Idiopathic Skeletal Hyperostosis and Spine Fractures at a High-Volume Trauma Center
Troy H. Caron, DO (n); Rick Bransford, MD (a-Synthes, Stryker, DePuy);
Jens Chapman, MD (a,c-Synthes, Stryker, DePuy; e-Synthes);
Carlo Bellabarba, MD (a-Synthes, Stryker, DePuy);
Harborview Medical Center, Seattle, Washington, USA
Purpose: Fractures of the spine in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are becoming more prevalent. The purpose of this paper is to evaluate the current treatment and outcomes of patients with these injuries. Fracture characteristics are also described.
Methods: In this retrospective study, 112 patients with a diagnosis of AS or DISH and fracture of the spine were identified from an institutional database searched from January 2000 to December 2006. Clinical records and spine imaging studies were reviewed from initial hospitalization to final follow-up.
Results: 122 spine fractures were treated in 112 patients with AS or DISH over a 7-year period, of which 55% were cervical and 45% were thoracolumbar. The average age of the patients was 67 years with a male to female ratio of approximately 6:1. 81% of patients had at least one major medical comorbidity. Spinal cord injury was present in 59% of patients overall, and in 70% of cervical and 36% of thoracolumbar injuries. Following treatment, neurologic status improved by at least one ASIA grade in 33% of these patients.
Surgery was performed on 66% of patients—78% posterior, 10% anterior, and 12% both posterior and anterior. On average, three levels were instrumented above and below the injury. 18% of patients required an unplanned second surgery.
The average length of hospitalization was 18 days. 84% of patients had at least one perioperative complication, the most common of which included pulmonary problems in 35%, urinary tract infections in 18%, and wound infections in 10%. The mortality rate was 32%. Mortality correlated with advanced age and cardiac disease. Patients with a low-energy mechanism of injury were three times more likely to die when compared to high-energy injury.
Our follow-up rate was 72%, and averaged 7 months. Fractures were most commonly transdiscal extension injuries (AO type B3). The most common level of injury was C6/7, followed by C5/6 and by T9/10. Radiographic alignment at follow-up was comparable to that noted postoperatively.
Conclusion/Significance: With a growing elderly population, the number of patients with ankylosing spinal disorders and multiple medical comorbidities who present with spinal fractures has increased. Neurologic injuries and complex care requirements were commonplace. Most patients had at least one complication and mortality was high. From a surgical perspective, segmental instrumentation three levels above and three levels below the injury provided satisfactory healing of the spine fracture.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.