Patients who were treated without trauma history, so we called this circumstance no-energy trauma (NET). In addition to demographic data, we evaluated the accident mechanism and injury levels.Ĭomplete data set with X-ray in two planes, MDCT, and subsequent whole body magnetic resonance imaging. All data were collected through a review of consecutive clinical records and imaging files. The objective of this study was to determine to what extent standard MRI of the whole spine performed in our hospital leads to an improved diagnosis in patients with Bechterew’s disease after LET or NET and thus leads to a change in the therapeutic strategy.įor the purpose of the study, we evaluated the data of 136 patients with confirmed Bechterew’s disease who required spinal stabilization in a level-one trauma and special spinal care centre between June 2010 and June 2018. In the literature, however, these two clinical diagnoses are often considered combined or partly overlapping, so data on larger patient collectives are missing. DISH is the only differential diagnosis of Bechterew’s disease that is associated with ventral spondylophyte formation. Furthermore, the current literature contains only a few cases of patients with Bechterew’s disease or diffuse idiopathic skeletal hyperostosis (DISH) with occult fractures, and thus, the risk of occult fractures as a consequence remains underestimated. In Europe, there is no standard recommendation to perform an initial diagnosis using magnetic resonance imaging (MRI) of the entire spinal column. However, initially overlooked fractures can lead to pain, secondary dislocations, stenosis, and neurological deficits. In contrast, for the reasons of fragility mentioned above, there is no standard diagnostic procedure for patients who experience a low-energy trauma (LET), and diagnosis is even more challenging for patients who experience a no-energy trauma (NET). Accordingly, an adequate trauma will lead to subsequent diagnostic assessment with thin-layer computed tomography (CT) if necessary in advance of plain radiographs. Moreover, both low bone mineral density and sarcopenia are found in the early stages of Bechterew’s disease. The prevalence of vertebral fractures in ankylosing spondylitis is almost 30% with the use of WHO criteria for osteoporosis. However, the fragility of patients with Bechterew’s disease is based on four substantial problems: long lever arm, osteoporosis, sarcopenia, and kyphosis with restriction of the visual axis. In the literature, there is a four-to-ten time higher lifetime risk of a person with ankylosing spondylitis being affected by a fracture of the spine compared to a normal cohort. These slides can be retrieved under Electronic Supplementary Material.Īnkylosing spondylitis in its severe manifestation is associated with a high risk of vertebral body fractures due to ossification of the ligaments. ConclusionĬonsidering the high percentage of our patient population with occult fractures, we recommend supplementing the basic diagnostic procedures with an MRI of the entire spinal column in patients with painful spinal column findings after minor trauma and for those with persistent pain without trauma. All fractures were treated surgically with stabilization and decompression if indicated. However, on X-ray and CT, the fractures were only visible at one height. Two fracture heights were observed in six patients who experienced LET. In ten of these patients (6 LET, 4 NET) in which a previous decision was made to follow conservative therapy, no fracture indication was found on CT or X-ray. After initial diagnostics (CT and X-ray) were performed in 15.4% of the patients with LET or NET ( n = 16), we found occult fractures on MRI scans. A total of 92 patients with LETs and 12 patients with NETs were included. One hundred and thirty-six patients with AS after trauma were surgically treated. The diagnostic and planned surgical procedure was examined initially and again after total spine MRI in patients with persistent and/or new complaints. MethodsĪll patients with AS, who underwent surgery after minor traumas (low-energy traumas, LETs) and patients without trauma history (NET: no-energy trauma), were retrospectively analysed. The purpose of this study was to determine the extent to which magnetic resonance imaging (MRI) performed in patients with ankylosing spondylitis (AS) after low- and no-energy trauma leads to an improved diagnosis and, as a result, to a change in the therapeutic strategy.
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