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Post-traumatic spinal hematoma in ankylosing spondylitis.

Riku M Vierunen1, Mika P Koivikko2, Jari O Siironen3

  • 1HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland. riku.vierunen@hus.fi.

Emergency Radiology
|January 16, 2021
PubMed
Summary

Spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) are common in post-traumatic ankylosing spondylitis (AS). Surgery improves outcomes, but the hematoma

Keywords:
Ankylosing spondylitisMagnetic resonance imagingSpinal epidural hematomaSpinal fractureSpinal subdural hematoma

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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.