Acta Rheumatologica

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Surgical Management of Fractures in Vertebrae with Enclosing Spondylitis - A Systematic Review with Newer Principles of Management

Suhasish Ray*, D.K.Jha and Bikramjit Gayen

Ankylosing Spondylosis is a type of seronegativearthritisthat causes inflammation and eventually fusion of the spineand the spinal joints. Involvement of peripheral joints andextraarticularmanifestations. It includes-Ankylosingspondylitis (AS); Diffuse idiopathic skeletal hyperostosis(DISH); End stage spondylosis multiform (EASM); Ossifiedposterior longitudinal ligament (OPLL). The prevalenceranges from 0.1 to 1 percent of the population, M>F,between15-40 years; 95% share the genetic marker HLA-B27. Numerous bony changes to spine include-Intraosseousbone loss; erosion; sclerosis; fractures; extra osseoussquaring; syndesmo and enthesophytes. Incidence ofvertebral fracture in patients with AS is 3.5 times higherthan in general population, 75% of the fractures occur in thecervical spine followed by the thoracic and lumbar spine.Spinal cord injury is about 11 times higher than the generalpopulation. Mean age of fracture is 63.4 years. Treatment ischallenging due to kyphosis, osteoporosis, with restrictivelung disease, and medical comorbidities. Treatment goalsare to reduce or prevent- inflammation, ankylosis, abnormalposture. The principle is to treat the fracture as long boneosteoporotic diaphyseal fracture. Apart from 360 fracturefixation with long construct, MIS surgery, other fracturemanagements in AS are deformity correction, laminectomy,laminoplasty, rhizotomy, neuromodulation.

Published Date: 2021-10-12; Received Date: 2020-07-20