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Article: Successful nonoperative treatment of a three-column thoracic fracture in a patient with ankylosing spondylitis: Existence and clinical significance of the fourth column of the spine

TitleSuccessful nonoperative treatment of a three-column thoracic fracture in a patient with ankylosing spondylitis: Existence and clinical significance of the fourth column of the spine
Authors
Issue Date2007
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2007, v. 32 n. 15, p. E423-E427 How to Cite?
AbstractSTUDY DESIGN. A case report. OBJECTIVE. To report the successful nonoperative management of a patient with progressive ankylosing spondylitis who sustained a three-column flexion-distraction injury of the upper thoracic spine with an intact sternal-rib complex, thereby emphasizing the existence and clinical relevance of the fourth-column concept in such patients. SUMMARY OF BACKGROUND DATA. Three-column injuries of the cervical and lumbar spine are typically unstable and require surgical stabilization. Patients with ankylosing spondylitis are at an increase risk to sustain three-column injuries of the spine due to their progressive inflammatory disease, a state that renders the spine brittle and alters its biomechanical function. A fourth-column model of the thoracic spine has been proposed and incorporates the sternal-rib complex; however, such a model has rarely been addressed in the literature and its role regarding three-column upper thoracic spine injury with an intact sternal-rib complex in patients with ankylosing spondylitis is unknown. METHODS. A 68-year-old white man with ankylosing spondylitis and Pickwickian body habitus sustained a three-column flexion-distraction injury at T5 following a ground-level fall. The patient complained of midthoracic back pain; however, he was neurologically intact and ambulated without aids. RESULTS. Because of the patient's numerous active medical issues that substantially increased his perioperative risks combined with symptomatic improvement of his pain, the patient refused surgical stabilization. In addition, because of the patient's body habitus and pulmonary issues, external brace immobilization was not tolerated. At 17 months of follow-up, the patient remained neurologically intact, ambulated well, his midthoracic back pain had subsided, and no progressive kyphosis was noted. CONCLUSIONS. This case confirms the existence and clinical relevance of the fourth column of the thoracic spine and its role in providing added spinal stability in the patient with ankylosing spondylitis. As such, it is still possible to achieve a favorable clinical outcome in a select subpopulation of patients with ankylosing spondylitis that sustain three-column flexion-distraction injuries who are neurologically intact and are not candidates for surgical stabilization. © 2007 Lippincott Williams & Wilkins, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/170111
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorShen, FHen_US
dc.contributor.authorSamartzis, Den_US
dc.date.accessioned2012-10-30T06:05:23Z-
dc.date.available2012-10-30T06:05:23Z-
dc.date.issued2007en_US
dc.identifier.citationSpine, 2007, v. 32 n. 15, p. E423-E427en_US
dc.identifier.issn0362-2436en_US
dc.identifier.urihttp://hdl.handle.net/10722/170111-
dc.description.abstractSTUDY DESIGN. A case report. OBJECTIVE. To report the successful nonoperative management of a patient with progressive ankylosing spondylitis who sustained a three-column flexion-distraction injury of the upper thoracic spine with an intact sternal-rib complex, thereby emphasizing the existence and clinical relevance of the fourth-column concept in such patients. SUMMARY OF BACKGROUND DATA. Three-column injuries of the cervical and lumbar spine are typically unstable and require surgical stabilization. Patients with ankylosing spondylitis are at an increase risk to sustain three-column injuries of the spine due to their progressive inflammatory disease, a state that renders the spine brittle and alters its biomechanical function. A fourth-column model of the thoracic spine has been proposed and incorporates the sternal-rib complex; however, such a model has rarely been addressed in the literature and its role regarding three-column upper thoracic spine injury with an intact sternal-rib complex in patients with ankylosing spondylitis is unknown. METHODS. A 68-year-old white man with ankylosing spondylitis and Pickwickian body habitus sustained a three-column flexion-distraction injury at T5 following a ground-level fall. The patient complained of midthoracic back pain; however, he was neurologically intact and ambulated without aids. RESULTS. Because of the patient's numerous active medical issues that substantially increased his perioperative risks combined with symptomatic improvement of his pain, the patient refused surgical stabilization. In addition, because of the patient's body habitus and pulmonary issues, external brace immobilization was not tolerated. At 17 months of follow-up, the patient remained neurologically intact, ambulated well, his midthoracic back pain had subsided, and no progressive kyphosis was noted. CONCLUSIONS. This case confirms the existence and clinical relevance of the fourth column of the thoracic spine and its role in providing added spinal stability in the patient with ankylosing spondylitis. As such, it is still possible to achieve a favorable clinical outcome in a select subpopulation of patients with ankylosing spondylitis that sustain three-column flexion-distraction injuries who are neurologically intact and are not candidates for surgical stabilization. © 2007 Lippincott Williams & Wilkins, Inc.en_US
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_US
dc.relation.ispartofSpineen_US
dc.subject.meshAccidental Fallsen_US
dc.subject.meshAgeden_US
dc.subject.meshBack Pain - Etiologyen_US
dc.subject.meshBraces - Adverse Effectsen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshPatient Selectionen_US
dc.subject.meshRecovery Of Functionen_US
dc.subject.meshRibs - Anatomy & Histologyen_US
dc.subject.meshSpinal Fractures - Etiology - Physiopathology - Therapyen_US
dc.subject.meshSpondylitis, Ankylosing - Complicationsen_US
dc.subject.meshSternum - Anatomy & Histologyen_US
dc.subject.meshThoracic Vertebrae - Pathology - Physiopathology - Radiographyen_US
dc.subject.meshTomography, X-Ray Computeden_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshTreatment Refusalen_US
dc.subject.meshWeight-Bearingen_US
dc.subject.meshWithholding Treatmenten_US
dc.titleSuccessful nonoperative treatment of a three-column thoracic fracture in a patient with ankylosing spondylitis: Existence and clinical significance of the fourth column of the spineen_US
dc.typeArticleen_US
dc.identifier.emailSamartzis, D:dspine@hku.hken_US
dc.identifier.authoritySamartzis, D=rp01430en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/BRS.0b013e318074d59fen_US
dc.identifier.pmid17621199-
dc.identifier.scopuseid_2-s2.0-34447306894en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34447306894&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume32en_US
dc.identifier.issue15en_US
dc.identifier.spageE423en_US
dc.identifier.epageE427en_US
dc.identifier.isiWOS:000248105800025-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridShen, FH=7201583245en_US
dc.identifier.scopusauthoridSamartzis, D=34572771100en_US

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