Fractures of the spine in ankylosing spondylitis BLJJ. Celineck und A. ßt: Cnrualtto Dcpartrnent.ofl)i;lgiioslic Iladiology. Municipal Hospital. Iliiivorsity of:larhus. Ucnmark
Fractures througli the disc o r t h e vertebral body a s well as t h e posterior elernents a r e typically scen in ankylosing spondylilis. The fractures can bt: compared to tho Irac:tures of long bones and a r e orten unstahlo. These fractures a r e usiially associated with increasing pain a n d ma.y hc the result orminor traumas. The radiographic nppcaraiic:ir niay be descreet. but ovcrlooking the fracturo rnay have disastious conscqiionc:i?s. 'I'hp chnractoristic reatures and the biornochariical pathogcnesis oflhese f'ractures a r c rcviewed.
1
.
Wirbelsiiulcnhakturen bei S ~ o n d" v i a r t h r i t i s ankylopoelica (Morbiis ßc8ch-
terew) Typische Begleiterscheinurigeri d e r Spondylarthritis ankylopoetica sind U . a. Frakturen d e r Bandscheiben bzw. Wirbelkörper urid d e r posterioien Antcilc d e r Wirbelkörpcr. Die Frakturen lassen sich mit Frakturen der Röhren- bzw. Markknochen vcrglcichen und sind oft instabil. Solche Frakturen gchen ineisl mit zunehmenden Schmerzen rinhcr und köririen auf kleiiiereri T r a u m a t a beruhcn. Die röntgenographischen Befunde können unter IJrnständen unscheinbar sein; dagegen kann ein Obersehen d e r jeweiligen Fraktur katastrophale Folgen haben. Die charakteristischen Merkmale und die biomechanische Pathogenese dieser Frakturen werden beschricbcn und diskutiert. -
Introduction In exterisive cases of ankylosing spondylilis (AC) wit,h syndesmophyte formation and ankylosis of the racct joints, the spine loses normal rnobilit,~a n d becomes vulnerable 10 minor traurnas. Relatively small traumas rnay cause fractures that a r e casily overlooked becaiise or an unusual radiographic rnanifeslation. 'J'he resulting pcrsistent pain rnay b c incorrectly attributed to thc spondylitis. The purposc ol'this presentation is to report three characleristic cases and to discuss the spccial problems connected with these rractures.
-
p~
Fortschr. Höntgenstr. 152.3(1990) 307 -310 O GeorgThiemc Vcrlag Stultgart . New York
--
-
. .
Cnsc 1: A 47-year-old male sulTeririg froiri AS ftrr 10 yrars. was hospitalizcd bccausc of pcrsistcnt low back pain. No traurna was known, but IIP had a streiiiious job ns n baker. Tho pain occurrcd spontaneously two weeks earlier and tiad corifiried him to bed. Ptiysical exnmination rcvcalcd no nrurological deficit and no obvious clinical sigris ol fractiire. I~lowovcr.n radiogrnphic exnmiriation pcrformcd a few days later showetl distiiic:L :lS changes aiid a traris\lcirso I'rncturo through thc body and thc postcrior structures of L 3 . indicating aiid unstable fracturo (Fig. 1 a aiid b). Tho paticnt was trcated with a plaster biindage and c:oiifinerneiitto bcid. Wlien he was allowcd to walk thc patient suddenly dcvelopcd leftsided drop-foul arid was agaiii c:onfiiiad to bcd. Regression of thc drop-foot followed. After 5 nionths oitruati~icn~ the fractiire was henied (Fig. I C).
C'ase 2: A 51-year-old male suKering froiri AS Tor niany years. was hospitnlized bccausc of a fall ori his back the day bcforc. rcsulting in severe pairi. Ttie patieril was exaininnd at thc eiiiergency room ofanothcr hospital but no radiographic exarriiiiation was perrornied aiid he was scnt hnmc. At the time of admission in this hospital next day. physical exaiiiination revenled distiiict. tendcrncss of thc dorsal spine at the T9-10 level. Radiographic examinatioii of the dorsnlumbar spino supplcmciited by planigraphy did not reveal any obvioiis fracture liiie, bul i t was reiiiarkabla that thcrc was a gap bctwcen the syndesmophytes anteriorly at ltie T9-10 IAVAI. nlthough syndnsmophytc bridge formation was present in the rerrininirig dorso luiiibar spirie. Ilowever. LIie study of carlicr radiographic exarninations of the sanie area revealed that there hnd Lieen syndesmophytcs antcriorly to thc mcntioncd disc space and ttiat the verticnl diaiiieter ol' this space hnd increasad. Furthcrmorc. a lateral displacement of a few rnillirnetres occurred betwaen T9 and T1 0 (Pig.2 a- C). Bccausc thc facct joints at the same level were ankylotic. ttiese observntii,ns suggesled a rrncture through thc syndcsmophytes around the disc and the posterior slriictiires of the vertebrn. Computcd tornography thcn confirmed this assessment (Fig. 2 d). iridicai.iiig iristahility. The patiant was troatcd with a bandagc of plaster and conlinement to bed. and duririg Iiealirig tlie bridge nf syndesmophytos at the T9 10 lovcl was formed again (Fig. 2e). There were iio neurological consequences. Casc?3: A 81-year-old filrnale, suffering frorn arikylosirig spoiidylitis, was hit by n car. Radiogaphic cxaminations rcvcalcd fractures of bolh legs. Ten days later rndiogrnphic exarninations of tho dorso-lumbar spine revealed a tiny fracture-liiie ol' '1'12 (Fig. 3 a aiid b). ßecnuse thc paticnt suffcrcd from ankylosing spondylitis. a Cl' of the relevaril area was perforrned. which sliowed an iinstablc fracturc through the body and posterior structures of'T12 (Fig. 2c). Tlie patient was cnnfincd to bod. Thcrc wcrc no ncurological consequencss. and 3 nioiiths later the fracture hnd liealed.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
I
C:asc rcports
S u m m a. r..y.....
Iri patients with advanced nnkvlosing spondylilis, Cractures of the spinc at lcvcls with syndosrnopliyt(? lorniation are of thc chalkstick type:, tlie fraclure line passing through thc body o r llie disc. I f t l i c iiitervertebral facet ,joints nro ankylosed, i t iriusl be assumed that the fractuic linc: cxtends Llirough the vertebral arch. resulting i n ins1.ability. These fractures can be comparcd to t.hu fi-ac:tiirt!s seeii iii loiig bones (1.4, 5, 7. 13). Thc: axis o f ilexiori and extension o f the spinc! norrniilly passes tlirough the nucleus pulposiis. whicli logether will1 the intervertebral joints and thc ligai r i r i i ~ sabsorb t h r trauma. This is not possible i n llie ankylosed spine. Bone can withstand rnore coriipression lorce than tensilc forcc. rc!sullirig iii grealer dainage to thosc parts oft.hc! spirie exposed to tensile forces. With flexion, thc antcrior portion o i the disc space comprcsscs i n norrnals, tlie poslcrior portion o l t h e disc spacc widcns, arid Llie lacet joints distract. When thc disc space and facel joiiits are ankylosed, thcy obvioiisly are rio loriger capable tu altering their conligiiratiori iri respoiise 10 load. 'l'hus, whcn an ankylosod spine is loaded. the axis shifts antcriorly i n Ilexiori, posleriorly i n extension (5). Thereforc thc li-acturo lino originales i n the posterior elemcnts i n floxiori. On the corilrary i t originates ant.criorly il'oxtonsioii occurs. for exaniple i f the paticnt falls forward oii i.o tlie head o r chcst. A parallel has been drawn bctwccn thc AS spine lraclure loaded i n flexion and thc fractiiro-dislocation o f lhe dorso-luinbar spinc i n an othcrwisc! norriial Person, associated with Inp scat bclt injuries. T t i r seat bell efiectively shifts thc axis ol' tlle spine aiiteriorly to its normal locntion i n t h e:eritre ~ o f t l i e riucleus pulposus, leading to n I'riictiirc: siiriilar to lhat Seen in AS ( 5 . 12). 'I'herr a rc! srvcral cha rac:leristic: probleins connectecl with fracturos ol'thc! spirie i n AS patients. 'l'he patients aro olton in pairi before Llie trauiiia. and a worsen-
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Fig. 1a-C A transverse fracture through the body and posterior structures of L 3 in a47-year old rnalesutlering from ankylosing sporidylitis. a-b) First exainination showin~thetransverse fracture C) 5 rnonths laler the fracture had healed.
ing of thc pain c i ~ roasily i b(: intorproted as an exacrrbalion of' Ihc inllarnriialory disease. The trauiiia h a t causes the I'racture is ollen a iiiinor oiie and the patient forgets it o r th(? exainiiier does n o t appreciate its significance. It may h(: very difficult to perform optimal radiographic cxarninations of an nnkyloscd and oft.(!n ostooporotic: spiiie. Furthcrmorc, changos that \vc!rc. preseril beforr llie Lrauma. rnay ronder 1lie radiological evalualioii dill?cult ( 2 . 3 . 5 . 6 . 8 . 11, 13). In case 1 thc patirnt was not radiographed primarily, becausc no obvious trauma had occurred and thc physical oxamiriation did riotsuggesl a kacture. I n case 2. the patient was 1101radiographed primarily because the iriirior traurna was rieglected. 'l'hc radiographic signs o f fracture were dubious. pa.rtly becnusr of osteoporosis thai. rendered the irnaging morc difficult. Only by roviewing oldcr rediographios arid by usirig c:orripiited loiriography was i t possible to achieve lhe correcldiagnosis. 'I'he treatment is often conservative, hut. iinstalsle fractiires o r neurological Symptoms rnay .rc!quire surgery. I f t.hc I'ractiirc is not trcatod, thcrc: is ii risk o f dcvcloping psoudoarthrosis ( I . 5, 6. 8. 9. 1.3). Conclusion
... -..
I n thc prcscncc of AS paticnts with increasing pain i n thc spinc!, tho possibility o f a f'racture should bo kcpt i n rnind, also aiter a iriiiior lrauina. Radiographic oxaniiiialiori of' the affected region o l Lhe spine should always include oblique views. Planigraphy and compiitcd tornography will often be necesssry for adeqiiatc irnaging. 'l'he fracture line is oftcn rnost atypical as cornparcd to i'ractiire lincs i n othcrwise riorrrial spinos. Frac:tures o f lhe chalkstick type l t i a l oi'ten iiivol\~esboth tlie aiiterior and posi.erior s~.ruci.ures.are typical. especially i n the presence of ankylolic facet joints. The fracture is often iinstnblc, although the radiographic rnanifcstntion is vcry discrcot. An ovrrlookcd fracturc i n apationt wi1.h AS m x y havo disast,rous consc:qucincc!s.
res of ll7e spine tn unkylostng spondylltrs -. .
-
Fig.2 a-e Fracture through syndesmophytes, disc space and posterior structuresof Ti(, in a 51-year old male suffering from AS. a) Plain film of the thoracolumbarspine before the trauma. band C)Transverse fracture through syndesmophyies and disc space without any visiblefracture Iine lhrough and posterior structures. The wedge-shape of T, indicates anold lracture. d) CT-scanof Tlo shows the ring fracture. e) After healing.
Fracture through the body and posteriorstructuresofT,2inan 81.yearoldfeinale, sufferingfromankylosingspondylitis. aand b)Transversefracture thebodyofT,, c)CTofT,,shows theringfracture.
-C
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
- -
310 -
Fortschr. Röntgenstr. 152.3
J. Gelineck und A. De Carvalho:Fractures of the spine in ankylosing spondylitis
References Bergmann, E. W.: Fractures of the ankylosed spine. J. Bone Joint Surg. (Am.) 31 (1949) 669-671 Cawley, M. I. D.. T. M. Chalmers. J. H. Kellgren, J. Ball: Destructive lesions of vertebral bodies in ankylosing spondylitis. Ann. Rheum. Dis. 31 (1972) 345-358 Dihlmann, W. C. Delling: Disco-vertebral destructive lesions (so-ca1ledAnderssonlesions)associatedwithankylosingspondyIitis. Skeletal Radiol. 3 (1978) 10-16 Erlendsson, J.. N. P. Mortensen, A. de Carualho: Columnafrakturer hos patienter med spondylitis ankylopoietica. Ugeskr. L=ger 146 (1984) 1292-1294 Gelman, M. I., J. S. Umber: Fractures of the thoracolurnbar spine in ankylosing spondylitis. Arner. J. Roentgenol. 130 (1978)
John Gelineck Department of Diagnostic Radiology R Municipal Hospital University of Aarhus DK-8000AarhusC
*
l0
58 (1985) 3-7
Hunter, T.. H. Dubo: Spinal fractures complicating ankylosing spondylitis. Ann. Intern. Med. 88 (1978) 546-549 Karlström, G., S. Olerudc Spinal pseudarthrosis with paraplegia in ankylosing spondylitis. Arch. Orthop. 98 (1981) 297-300 Leslie, I. J.: Fracture dislocation of the ankylosed thoracic spine. Injury 9 (1977) 53-56 Seignon. B., M.-0. Tellart. J.-C. Etienne, J.-F. Robert. J. GougeOn: ,Spondylodiscites" de la pelvispondylite rhumatismale: L6sion inflammatoire ou Iesion mecanique? Rhumatologie 26 (1974) 33-45
l2
Smith, W. S., H. Kaufer: Patterns and mechanism of lumbar injuries associated with lap seat belts. J. Bone Joint Surg. (Am.) 51
l3
Thorngren, K.-G., J. E. Liedberg, P. Aspelin: Fractures of the thoracic and lumbar spine in ankylosing spondyiitis. Arch. Orthop. 98 (1981) 101-107
(1969) 239-254
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
485-491
Crisolia. A., R. L. Bell, L. F. Peltier: Fractures and dislocations of the spine complicating ankylosing spondylitis. J. Bone Joint Surg. (Am.) 49 (1967) 339-344 Harding. J. R.. W. McCall, W. M. Park, B. F. Jones: Fracture of the cervical spine in ankylosing spondyiitis. British Jour. Radiol.
Fractures througli the disc o r t h e vertebral body a s well as t h e posterior elernents a r e typically scen in ankylosing spondylilis. The fractures can bt: compared to tho Irac:tures of long bones and a r e orten unstahlo. These fractures a r e usiially associated with increasing pain a n d ma.y hc the result orminor traumas. The radiographic nppcaraiic:ir niay be descreet. but ovcrlooking the fracturo rnay have disastious conscqiionc:i?s. 'I'hp chnractoristic reatures and the biornochariical pathogcnesis oflhese f'ractures a r c rcviewed.
1
.
Wirbelsiiulcnhakturen bei S ~ o n d" v i a r t h r i t i s ankylopoelica (Morbiis ßc8ch-
terew) Typische Begleiterscheinurigeri d e r Spondylarthritis ankylopoetica sind U . a. Frakturen d e r Bandscheiben bzw. Wirbelkörper urid d e r posterioien Antcilc d e r Wirbelkörpcr. Die Frakturen lassen sich mit Frakturen der Röhren- bzw. Markknochen vcrglcichen und sind oft instabil. Solche Frakturen gchen ineisl mit zunehmenden Schmerzen rinhcr und köririen auf kleiiiereri T r a u m a t a beruhcn. Die röntgenographischen Befunde können unter IJrnständen unscheinbar sein; dagegen kann ein Obersehen d e r jeweiligen Fraktur katastrophale Folgen haben. Die charakteristischen Merkmale und die biomechanische Pathogenese dieser Frakturen werden beschricbcn und diskutiert. -
Introduction In exterisive cases of ankylosing spondylilis (AC) wit,h syndesmophyte formation and ankylosis of the racct joints, the spine loses normal rnobilit,~a n d becomes vulnerable 10 minor traurnas. Relatively small traumas rnay cause fractures that a r e casily overlooked becaiise or an unusual radiographic rnanifeslation. 'J'he resulting pcrsistent pain rnay b c incorrectly attributed to thc spondylitis. The purposc ol'this presentation is to report three characleristic cases and to discuss the spccial problems connected with these rractures.
-
p~
Fortschr. Höntgenstr. 152.3(1990) 307 -310 O GeorgThiemc Vcrlag Stultgart . New York
--
-
. .
Cnsc 1: A 47-year-old male sulTeririg froiri AS ftrr 10 yrars. was hospitalizcd bccausc of pcrsistcnt low back pain. No traurna was known, but IIP had a streiiiious job ns n baker. Tho pain occurrcd spontaneously two weeks earlier and tiad corifiried him to bed. Ptiysical exnmination rcvcalcd no nrurological deficit and no obvious clinical sigris ol fractiire. I~lowovcr.n radiogrnphic exnmiriation pcrformcd a few days later showetl distiiic:L :lS changes aiid a traris\lcirso I'rncturo through thc body and thc postcrior structures of L 3 . indicating aiid unstable fracturo (Fig. 1 a aiid b). Tho paticnt was trcated with a plaster biindage and c:oiifinerneiitto bcid. Wlien he was allowcd to walk thc patient suddenly dcvelopcd leftsided drop-foul arid was agaiii c:onfiiiad to bcd. Regression of thc drop-foot followed. After 5 nionths oitruati~icn~ the fractiire was henied (Fig. I C).
C'ase 2: A 51-year-old male suKering froiri AS Tor niany years. was hospitnlized bccausc of a fall ori his back the day bcforc. rcsulting in severe pairi. Ttie patieril was exaininnd at thc eiiiergency room ofanothcr hospital but no radiographic exarriiiiation was perrornied aiid he was scnt hnmc. At the time of admission in this hospital next day. physical exaiiiination revenled distiiict. tendcrncss of thc dorsal spine at the T9-10 level. Radiographic examinatioii of the dorsnlumbar spino supplcmciited by planigraphy did not reveal any obvioiis fracture liiie, bul i t was reiiiarkabla that thcrc was a gap bctwcen the syndesmophytes anteriorly at ltie T9-10 IAVAI. nlthough syndnsmophytc bridge formation was present in the rerrininirig dorso luiiibar spirie. Ilowever. LIie study of carlicr radiographic exarninations of the sanie area revealed that there hnd Lieen syndesmophytcs antcriorly to thc mcntioncd disc space and ttiat the verticnl diaiiieter ol' this space hnd increasad. Furthcrmorc. a lateral displacement of a few rnillirnetres occurred betwaen T9 and T1 0 (Pig.2 a- C). Bccausc thc facct joints at the same level were ankylotic. ttiese observntii,ns suggesled a rrncture through thc syndcsmophytes around the disc and the posterior slriictiires of the vertebrn. Computcd tornography thcn confirmed this assessment (Fig. 2 d). iridicai.iiig iristahility. The patiant was troatcd with a bandagc of plaster and conlinement to bed. and duririg Iiealirig tlie bridge nf syndesmophytos at the T9 10 lovcl was formed again (Fig. 2e). There were iio neurological consequences. Casc?3: A 81-year-old filrnale, suffering frorn arikylosirig spoiidylitis, was hit by n car. Radiogaphic cxaminations rcvcalcd fractures of bolh legs. Ten days later rndiogrnphic exarninations of tho dorso-lumbar spine revealed a tiny fracture-liiie ol' '1'12 (Fig. 3 a aiid b). ßecnuse thc paticnt suffcrcd from ankylosing spondylitis. a Cl' of the relevaril area was perforrned. which sliowed an iinstablc fracturc through the body and posterior structures of'T12 (Fig. 2c). Tlie patient was cnnfincd to bod. Thcrc wcrc no ncurological consequencss. and 3 nioiiths later the fracture hnd liealed.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
I
C:asc rcports
S u m m a. r..y.....
Iri patients with advanced nnkvlosing spondylilis, Cractures of the spinc at lcvcls with syndosrnopliyt(? lorniation are of thc chalkstick type:, tlie fraclure line passing through thc body o r llie disc. I f t l i c iiitervertebral facet ,joints nro ankylosed, i t iriusl be assumed that the fractuic linc: cxtends Llirough the vertebral arch. resulting i n ins1.ability. These fractures can be comparcd to t.hu fi-ac:tiirt!s seeii iii loiig bones (1.4, 5, 7. 13). Thc: axis o f ilexiori and extension o f the spinc! norrniilly passes tlirough the nucleus pulposiis. whicli logether will1 the intervertebral joints and thc ligai r i r i i ~ sabsorb t h r trauma. This is not possible i n llie ankylosed spine. Bone can withstand rnore coriipression lorce than tensilc forcc. rc!sullirig iii grealer dainage to thosc parts oft.hc! spirie exposed to tensile forces. With flexion, thc antcrior portion o i the disc space comprcsscs i n norrnals, tlie poslcrior portion o l t h e disc spacc widcns, arid Llie lacet joints distract. When thc disc space and facel joiiits are ankylosed, thcy obvioiisly are rio loriger capable tu altering their conligiiratiori iri respoiise 10 load. 'l'hus, whcn an ankylosod spine is loaded. the axis shifts antcriorly i n Ilexiori, posleriorly i n extension (5). Thereforc thc li-acturo lino originales i n the posterior elemcnts i n floxiori. On the corilrary i t originates ant.criorly il'oxtonsioii occurs. for exaniple i f the paticnt falls forward oii i.o tlie head o r chcst. A parallel has been drawn bctwccn thc AS spine lraclure loaded i n flexion and thc fractiiro-dislocation o f lhe dorso-luinbar spinc i n an othcrwisc! norriial Person, associated with Inp scat bclt injuries. T t i r seat bell efiectively shifts thc axis ol' tlle spine aiiteriorly to its normal locntion i n t h e:eritre ~ o f t l i e riucleus pulposus, leading to n I'riictiirc: siiriilar to lhat Seen in AS ( 5 . 12). 'I'herr a rc! srvcral cha rac:leristic: probleins connectecl with fracturos ol'thc! spirie i n AS patients. 'l'he patients aro olton in pairi before Llie trauiiia. and a worsen-
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Fig. 1a-C A transverse fracture through the body and posterior structures of L 3 in a47-year old rnalesutlering from ankylosing sporidylitis. a-b) First exainination showin~thetransverse fracture C) 5 rnonths laler the fracture had healed.
ing of thc pain c i ~ roasily i b(: intorproted as an exacrrbalion of' Ihc inllarnriialory disease. The trauiiia h a t causes the I'racture is ollen a iiiinor oiie and the patient forgets it o r th(? exainiiier does n o t appreciate its significance. It may h(: very difficult to perform optimal radiographic cxarninations of an nnkyloscd and oft.(!n ostooporotic: spiiie. Furthcrmorc, changos that \vc!rc. preseril beforr llie Lrauma. rnay ronder 1lie radiological evalualioii dill?cult ( 2 . 3 . 5 . 6 . 8 . 11, 13). In case 1 thc patirnt was not radiographed primarily, becausc no obvious trauma had occurred and thc physical oxamiriation did riotsuggesl a kacture. I n case 2. the patient was 1101radiographed primarily because the iriirior traurna was rieglected. 'l'hc radiographic signs o f fracture were dubious. pa.rtly becnusr of osteoporosis thai. rendered the irnaging morc difficult. Only by roviewing oldcr rediographios arid by usirig c:orripiited loiriography was i t possible to achieve lhe correcldiagnosis. 'I'he treatment is often conservative, hut. iinstalsle fractiires o r neurological Symptoms rnay .rc!quire surgery. I f t.hc I'ractiirc is not trcatod, thcrc: is ii risk o f dcvcloping psoudoarthrosis ( I . 5, 6. 8. 9. 1.3). Conclusion
... -..
I n thc prcscncc of AS paticnts with increasing pain i n thc spinc!, tho possibility o f a f'racture should bo kcpt i n rnind, also aiter a iriiiior lrauina. Radiographic oxaniiiialiori of' the affected region o l Lhe spine should always include oblique views. Planigraphy and compiitcd tornography will often be necesssry for adeqiiatc irnaging. 'l'he fracture line is oftcn rnost atypical as cornparcd to i'ractiire lincs i n othcrwise riorrrial spinos. Frac:tures o f lhe chalkstick type l t i a l oi'ten iiivol\~esboth tlie aiiterior and posi.erior s~.ruci.ures.are typical. especially i n the presence of ankylolic facet joints. The fracture is often iinstnblc, although the radiographic rnanifcstntion is vcry discrcot. An ovrrlookcd fracturc i n apationt wi1.h AS m x y havo disast,rous consc:qucincc!s.
res of ll7e spine tn unkylostng spondylltrs -. .
-
Fig.2 a-e Fracture through syndesmophytes, disc space and posterior structuresof Ti(, in a 51-year old male suffering from AS. a) Plain film of the thoracolumbarspine before the trauma. band C)Transverse fracture through syndesmophyies and disc space without any visiblefracture Iine lhrough and posterior structures. The wedge-shape of T, indicates anold lracture. d) CT-scanof Tlo shows the ring fracture. e) After healing.
Fracture through the body and posteriorstructuresofT,2inan 81.yearoldfeinale, sufferingfromankylosingspondylitis. aand b)Transversefracture thebodyofT,, c)CTofT,,shows theringfracture.
-C
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
- -
310 -
Fortschr. Röntgenstr. 152.3
J. Gelineck und A. De Carvalho:Fractures of the spine in ankylosing spondylitis
References Bergmann, E. W.: Fractures of the ankylosed spine. J. Bone Joint Surg. (Am.) 31 (1949) 669-671 Cawley, M. I. D.. T. M. Chalmers. J. H. Kellgren, J. Ball: Destructive lesions of vertebral bodies in ankylosing spondylitis. Ann. Rheum. Dis. 31 (1972) 345-358 Dihlmann, W. C. Delling: Disco-vertebral destructive lesions (so-ca1ledAnderssonlesions)associatedwithankylosingspondyIitis. Skeletal Radiol. 3 (1978) 10-16 Erlendsson, J.. N. P. Mortensen, A. de Carualho: Columnafrakturer hos patienter med spondylitis ankylopoietica. Ugeskr. L=ger 146 (1984) 1292-1294 Gelman, M. I., J. S. Umber: Fractures of the thoracolurnbar spine in ankylosing spondylitis. Arner. J. Roentgenol. 130 (1978)
John Gelineck Department of Diagnostic Radiology R Municipal Hospital University of Aarhus DK-8000AarhusC
*
l0
58 (1985) 3-7
Hunter, T.. H. Dubo: Spinal fractures complicating ankylosing spondylitis. Ann. Intern. Med. 88 (1978) 546-549 Karlström, G., S. Olerudc Spinal pseudarthrosis with paraplegia in ankylosing spondylitis. Arch. Orthop. 98 (1981) 297-300 Leslie, I. J.: Fracture dislocation of the ankylosed thoracic spine. Injury 9 (1977) 53-56 Seignon. B., M.-0. Tellart. J.-C. Etienne, J.-F. Robert. J. GougeOn: ,Spondylodiscites" de la pelvispondylite rhumatismale: L6sion inflammatoire ou Iesion mecanique? Rhumatologie 26 (1974) 33-45
l2
Smith, W. S., H. Kaufer: Patterns and mechanism of lumbar injuries associated with lap seat belts. J. Bone Joint Surg. (Am.) 51
l3
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