Patients with ankylosed and spondylotic spine can suffer cervical injury even after minor trauma. Therefore, the patients who present with neck pain or neurologic deficit after major or minor trauma should be considered to have a cervical spine injury until proven otherwise.
Degenerative spondylotic changes, such as vertebral body osteophytes, fixed subluxations, and facet hypertrophy can make plain films difficult to interpret. Therefore unless the injury is severe, the plain x-rays may not be helpful in detecting a level of injury.
If xrays do not reveal mush information CT or MRI should be done in these patients.
Two situations warrant more discussion
- Fractures in patients with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis
- Spinal cord injuries in patients with cervical spondylosis without ligamentous or bony instability.
Fractures with Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis
Due to ankylosis the spine can no longer be considered as constituted of multiple motion segments. Instead the ankylosed spine should be considered as a long bone.
Bridging osteophytes in these diseases fuse the spine into a solid, continuous piece of bone. If there is a break in one region, it is likely to have propagated through both the anterior and posterior elements. Therefore any fracture in the cervical spine in these patients should be considered as unstable and treated accordingly.
Patients should be immobilized as soon as the diagnosis is made, admitted, and placed on strict log-roll precautions until definitive management.
Halo fixation, anterior fixation and posterior fixation are the treatment options in these patients though optimal treatment has not yet been formulated in the literature.
Spinal Cord Injury In Spondylotic Spine
There is an underlying cervical stenosis in these patients following the degenerative changes which increase the risk for neural injury.
Patients often present with complete or incomplete spinal cord injury without x-ray signs. CT or MRI as desired may be asked
Again there is a shortage of data on what is optimal treatment.
Nonoperative Treatment
It includes rest, collar immobilization and observation in particular for patients with central cord lesions, in which a high percentage will have nearly complete resolution of their neural deficits. Decision for long term definitive treatment is influenced by the presence of persistent signs or symptoms or myelopathy.
Operative Treatment
Those patient who have unstable spine or do not recover are treated with surgery. The treatment depends on cervical injury level and the presence or absence of myelopathy.
I am a 34 years old man.I have taken a MRI 5 years ago because of back pain and doctor diagnosis was herrinated disk in l5-s1 and l4-l5.I had back pain occasionally and I had to rest some days.Last year,after one of these back pain periods ,when i wanted to begin my daily works after getting up in mornings and walking a while,I felt stiffness in my back and pelvis(I feel that there is very much water in these parts of my body)that better in the length of day.but if I lied down or sitting down again this state removed and I had no more problem.I went to a romatologist and she told me to have blood test,pelvis x ray and MRI. The blood test and MRI results were normal but when she saw pelvis x ray ,she said she doubt to as.in bone mass test I had osteopenia,so she prescribed calcium d ,omega3,indometacin and vitamin D ampule.when i have taken indometacins I felt better .Recently she has prescribed naproxen instead of indometacin.but now after one year of beginning of my pains,(if I don’t have drugs I felt stiffness in my side and belly muscles in mornings.As I said most of my problem is awhile of standing and walking but when I sitting down or lying down my problem will remove.
Would you please guide me.
THANKS.
MOHSEN
Dr Arun Pal Singh Reply:
July 9th, 2011 at 8:30 am
@mohsen,
What do you wish to know?
Dear doctor :
I had left sided headache for 3years and my chiropractor said I have c2misalignment but x ray showed nothing wrong. 3months ago during swimming, I hyperextented my head backwards and I heard a click sound then left sided headache disappeared forever, I was happy at first but then I felt c2 kept popping out many times, if it’s out, I experienced right forehead pain , once I lay down on my back, the pain gradually disappeared but then I can muscles behind both my ears are tight . I has flexion and extension x ray but it showed no spondylolithesis .
Please tell me is there a x ray called left bend and right bend x ray which will identify the c2 slip out towards right downwards? Which other test can identify whether I have c2 spondylolithesis or not.
Thank you for your time.
Lily from uk
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:34 pm
@Lily king,
All you need is a consultation with a specialist in your vicinity.
Let him/her know the symptoms and you would be examined for relevant causes.
Based on your history and examination conducted by, the doctor would recommend the required investigation.
Blind investigations are of no use.