Artikel
Intraoperative myelography of traumatic spine injuries on patients with ankylosing spondylitis – Technical Note
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Autoren
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Michael Schwake
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Christian Ewelt
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Stephanie Schipmann
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Tarek Zoubi
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Kushtrim Shala
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Walter Stummer
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
Text
Background: Ankylosing spondylitis (AS) is an autoimmune inflammatory arthritis causing ossifications and rigidity of the spinal column. Patients with AS have a high incidence of spinal fractures, especially in the cervical spine, with a high rate of epidural hematomas. These have hazardous consequences including neurological sequelae, high morbidity and mortality. Diagnostics relay on CT and MRI scans, and therapy, usually open decompression and fixation, has to be done as soon as possible to enable recovery. However, in many cases performing MRI scans in not possible for several reasons.
Materials and methods: We present a case of an AS patient with paraparesis below T-8 after a fall, who was not able to undergo MRI scan due to severe obesity, hyperkyphosis and mechanical ventilation. CT scan did not demonstrate any fractures of the thoracic spine and in addition a standard myeolography could not be performed due to ossifications of ligaments. As an alternative we performed an intra-operative myeolgraphy.
Results: Intra-operative installation of a lumbar drain made a myelography and post myelographic CT scan feasible. The scan revealed a contrast stop at T-10 and subsequently operative decompression and evacuation of the hematoma were performed.
Conclusion: We present a quick and save technique, performed in the operation room (OR) to detect intra-spinal lesions in patients with contraindications for MRI, or for cases where MRI scans cannot be performed.
