Post-traumatic spinal hematoma in ankylosing spondylitis.

Area of Science:

• Spinal Imaging and Radiology
• Rheumatology and Autoimmune Diseases
• Neurosurgery and Traumatology

Background:

• Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine.
• Post-traumatic complications in AS patients can lead to significant morbidity.
• Spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) are rare but serious complications.

Purpose of the Study:

• To investigate the incidence, location, and MRI characteristics of SEH and SSH in post-traumatic AS.
• To correlate imaging findings with neurological deficits and surgical outcomes.

Main Methods:

• Retrospective review of 2256 spinal MRI referrals over 8 years and 9 months.
• Identified 32 patients with AS and spinal fracture; analyzed hematoma presence and MRI features.
• Two musculoskeletal radiologists assessed images for hematoma, canal narrowing, and cord impingement.

Main Results:

• Of 28 post-traumatic AS patients, 19 had SEH and 5 had SSH.
• Significant neurological improvement observed post-surgery (Frankel grade, p=0.008).
• Spinal cord impingement correlated with more severe neurological deficits (p=0.012); T1 heterogeneity indicated delayed imaging (p=0.047).

Conclusions:

• SEH and SSH are frequent complications in post-traumatic AS.
• Surgical intervention appears beneficial for these patients.
• The independent contribution of spinal hematoma to neurological deficits requires further investigation.