Traumatic spinal cord injury as a complication to ankylosing spondylitis. An extended report

Käpylä Rehabilitation Centre is in Finland the only unit taking care of the subacute rehabilitation activities of patients with spinal cord injury (SCI). The annual incidence of new patients with SCI is 55 (1.1 per 100,000 inhabitants). The ankylosed spine (AS) is reported to be at greater risk for fracture and SCI. The aim of the study was to clarify if this higher risk of ankylosing spondylitis (AS) could also be detected among patients with traumatic SCI rehabilitated at Käpylä Rehabilitation Centre. Further, the aim was to evaluate the characteristics of patients with traumatic SCI as a complication to AS in order to develop prevention of SCI in patients with AS.

Patient data was gathered from the patient register covering all Finnish patients with traumatic SCI (n = 1,103) rehabilitated at Käpylä Rehabilitation Centre from the year 1979 to 1998. The patient journals were subjected to a detailed and systematic analysis. Data about patients with a history of AS (n = 19; 18 men, 1 woman) was then compared to the data about all the patients with SCI (n = 1,103; 902 men, 201 women).

Based on the national prevalence data, the incidence rate of patients with AS for traumatic SCI was found to be 11.4 times greater than expected for the population at large. The mean age of the patients with AS was clearly higher (55.3 yrs) than the mean age of the whole group of patients (36.4 yrs) with traumatic SCI. The neurologic injury was at the cervical level in 84% of the patients with AS, but only in 48% of the patients with traumatic SCI in general. Among the patients with AS, the SCI was caused by slipping in 53% of the cases, whereas slipping was the reason for SCI only in 7% of the cases in general.

Patients with AS seem to run a higher risk of traumatic SCI than the people at large, and the injury levels are higher. In particular, male patients with advanced AS should be instructed to install preventive devices such as night lights and handrails, supports or head rests when driving a car, and they should avoid walking on slippery surfaces, loose carpets etc. They also should be encouraged to avoid excessive use of alcohol and activities involving the risk of physical injury such as contact sports.