Neurocirugía Neurocirugía
Neurocirugia.2006;17:440-4 - Vol. 17 Núm.5 DOI: 10.1016/S1130-1473(06)70328-1
Fractura transdiscal y subluxación C5-C6 en paciente con espondilitis anquilopoyética
C5-C6 transdiscal fracture and subluxation in a patient with ankylosing spondylitis
A. Carrillo-Colmenero, T. García-de la Oliva
Servicios de Radiodiagnóstico. Hospital Regional Universitario Carlos Haya. Málaga
H.F. Cabrera Ortiz
* Servicios de Neurocirugía. Hospital Regional Universitario Carlos Haya. Málaga
Recibido 01 octubre 2004, Aceptado 07 marzo 2005
Resumen

La fractura cervical es una posible complicación, no infrecuente, de la espondilitis anquilopoyética (EA) de larga evolución.

La actual nota clínica recoge un caso registrado en nuestro hospital, consistente en una fractura transdiscal y luxación C5-C6, con paraplejia final residual.

Su gravedad, pues, radica en su importante morbimortalidad en este tipo de pacientes.

El presente artículo centra su atención sobre el diagnóstico precoz, que posibilitará un manejo terapéutico personalizado, y sobre la prevención, en la medida de lo posible, de esta grave complicación.

Analizamos el contexto clínico del paciente, los factores predisponentes, el mecanismo lesional, la expresión radiológica, las secuelas neurológicas y el manejo terapéutico.

Summary

Cervical fracture is not a rare complication of longterm ankylosing spondylitis (AS). We are reporting a case of cervical fracture in a patient affected by which was complicated by a transdiscal fracture, C5-C6 subluxation, and residual paraplegia.

We analyse clinical presentation, predisponent factors, injury mechanism, radiologic features, neurological deficits, and terapeutic management.

We discuss the accurate diagnosis and the most suitable treatment for this serious complication, as well as prevention measures.

Palabras clave
Espondilitis anquilopoyética, Fractura cervical, Lesión neurológica, STIR, TAC
Key words
Ankylosing spondylitis, Cervical fracture, Cervical subluxation
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Bibliografía
1.
S. Alto,A. Pieri,M. D’Andrea
Primary prevention of deep venous trombosis and pulmonary embolism in acute spinal cord injured patients
Spinal Cord, 40 (2002), pp. 300-303
2.
H. Alaranta,S. Luoto,Y.T. Konttinnen
Traumatic spinal cord injury as a complicacion to ankylosing spondylitis. An extended report
Clin Exp Rheumatol, 20 (2002), pp. 66-68
3.
D.F. Apple,C. Anson
Spinal cord injury occurring in patients with ankylosing spondylitis: a multicenter study
Orthopedics, 18 (1995), pp. 1005-1011
4.
L. Bennett,K. Ohashi,G. El-Khoury
Spondyloarhropatles: ankylosing spondylitis and psoriasic arthritis
Radiol Clin N Am, 42 (2004), pp. 121-134
5.
K.N. Detwiler,C.M. Loftus,J.C. Godersky,A.H. Menezes
Management of cervical spine injuries in patients with ankylosing spondylitis
J Neurosurg, 72 (1990), pp. 210-215
6.
G. Exner,U. Bötel,P. Kluger,M. Richter,C. Eggers,M. Ruidisch
Treatment of fracture and complication of cervical spine with ankylosing spondylitis
Spinal Cord, 36 (1998), pp. 377-379
7.
J.A. Finkelstein,J.R. Chapman,S. Mirza
Occult vertebral fractures in ankylosyng spondylitis
Spinal Cord, 37 (1999), pp. 444-447
8.
M.W. Fox,B.M. Onofrio,J.E. Kilgore
Neurological complication of ankylosing spondylitis: the intervertebral disc as a cause of cord compression
J Neurosurg, 77 (1992), pp. 241-246
9.
J.A. Hanson,S. Mirza
Predisposition for spinal fracture in ankylosing spondylitis
AJR, 174 (2000), pp. 150
10.
P.W. Hitchon,A.M. From,M.D. Brenton,J.A. Glaser,J.C. Torner
Fractures of the thoracolumbar spine complicatiog ankylosing spondylitis
J Neurosurg Spine, 97 (2002), pp. 218-222
11.
T. Hunter,B. Forster,M. Dvorak
Ankylosed spines are prone to fracture
Can Fam Physician, 41 (1995), pp. 1213-1216
12.
D. Karasick,M.E. Schweitzer,N.A. Abidi,J.M. Cotler
Fractures of vertebrae with spinal cord injuries in patients with ankylosing spondylitis: Imaging Findings
AJR, 165 (1995), pp. 1205-1208
13.
M. Kauppi,E.A. Belt,l. Soini
“Bamboo spine” starts to bend-something is wrong
Clin Exp Rheumatol, 18 (2000), pp. 513-514
14.
D.S. Levine,S.M. Forbat,A. Saifuddin
MRI of the axial skeletal manifestations of ankylosing spondylitis
Clin Radiol, 59 (2004), pp. 400-413
15.
D. Mitra,D.M. Elvins,D.J. Speden,A.J. Collins
The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density
Rheumatol, 39 (2000), pp. 85-89
16.
A.P.M. Moreau,N. Willcox,M.F. Brown
Immobilisation of spinal fractures in patients with ankylosing spondylitis: Two case reports
Injury, 34 (2003), pp. 372-373
17.
S. Ozgocmen,O. Ardicoglu
Odontoid fracture complicating ankylosing spondylitis
Spinal Cord, 38 (2000), pp. 117-119
18.
D. Resnick
Traumatismos físicos
Huesos y Articulaciones en Imagen, pp. 717-818
19.
D.W. Rowed
Management of cervical spinal cord injury in ankylosing spondylitis: the intervertebral disc as a cause of cord compresión
J Neurosurg, 77 (1992), pp. 241-246
20.
Taggard, D.A., Traynelis, V.C.: Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation. Spine 25; 16: 2035–2039.
21.
N. Ticó,S. Ramón,García-Ortun
Traumatic spinal cord injury complicating ankylosing spondylitis
Spinal Cord, 36 (1998), pp. 349-352
22.
Ting-Fang Shih, T., Chen, P., Li, Y., Hsu, C.H.: Spinal fractures and pseudoarthrosis complicating ankylosing spondylitis: MRI manifestation and clinical significance. J Comput Assist Tomogr; 25: 164–170.
23.
S. Yilmazlar,H. Kocaeli,M. Doygun
Chance type cervical fracture and neurological deficits in ankylosing spondylitis
Ulus Trauma Derg, 9 (2003), pp. 76-78

Carrillo-Colmenero, A.; García-de la Oliva, T.; Cabrera Ortiz, H.F.: Fractura transdiscal y subluxación C5-C6 en paciente con espondilitis anquilopoyética. Neurocirugía 2006; 17: 440–444.

Correspondencia postal: Servicio de Radiodiagnóstico. Hospital Regional Universitario Carlos Haya. Málaga.
Copyright © 2006. Sociedad Española de Neurocirugía
Neurocirugia.2006;17:440-4 - Vol. 17 Núm.5 DOI: 10.1016/S1130-1473(06)70328-1