Spinal instability in ankylosing spondylitis

Area of Science:

• Orthopedics and Spine Surgery
• Rheumatology
• Neurology

Background:

• Unstable spinal lesions are a frequent complication in ankylosing spondylitis, often leading to neurological deficits.
• The progression and clinical presentation of these spinal lesions in ankylosing spondylitis remain incompletely understood.
• Management strategies for spinal instability in ankylosing spondylitis can be challenging and require careful consideration.

Purpose of the Study:

• To retrospectively analyze the mechanisms of injury, clinical presentations, and management strategies for spinal instability in ankylosing spondylitis.
• To evaluate the surgical outcomes, including pain relief, neurological recovery, and fusion rates, in patients with ankylosing spondylitis and unstable spinal lesions.

Main Methods:

• Retrospective analysis of 16 surgically treated ankylosing spondylitis patients with unstable spinal lesions (1995-2007).
• Evaluation of trauma mechanisms (low vs. high energy), presenting symptoms (pain, neurological deficit), and surgical approaches (anterior, posterior, combined).
• Assessment of outcomes using pain scores, Frankel neurological grading, deformity progression, and radiological fusion, with a mean follow-up of 54.5 months.

Main Results:

• Significant improvement in pain (Visual Analogue Score from 8 to 2) and neurological status (90% improvement in deficit patients).
• Frankel grading improved in 56.25% of patients; fusion achieved in 68.7%, with pseudoarthrosis in 12.5%.
• 68.7% regained pre-injury function; 25% experienced chronic pain or deformity; one patient died from medical complications post-surgery.

Conclusions:

• High index of suspicion and extensive radiological evaluation are crucial for diagnosing unstable spinal lesions in ankylosing spondylitis.
• Surgical intervention is indicated for neurological deficits, significant pain, progressive deformity, or multi-column spinal injuries.
• Long segment instrumentation and fusion represent the ideal surgical approach for managing spinal instability in ankylosing spondylitis.