-
Emergency Radiology Jun 2022To examine the incidence, location, and grade of blunt cerebrovascular injury (BCVI), as well as associated strokes in patients with ankylosis of the cervical spine,...
PURPOSE
To examine the incidence, location, and grade of blunt cerebrovascular injury (BCVI), as well as associated strokes in patients with ankylosis of the cervical spine, imaged with CT angiography (CTA) after blunt trauma. The related etiologies of ankylosis had an additional focus.
MATERIALS AND METHODS
Altogether of 5867 CTAs of the craniocervical arteries imaged after blunt trauma between October 2011 and March 2020 were manually reviewed for a threshold value of ankylosis of at least three consecutive cervical vertebrae. BCVI was the primary outcome and associated stroke as the secondary outcome. Variables were craniofacial and cervical spine fractures, etiology and levels of ankylosis, traumatic brain injury, spinal hematoma, spinal cord injury, and spinal cord impingement, for which correlations with BCVI were examined.
RESULTS
Of the 153 patients with ankylosis and blunt trauma of the cervical spine, 29 had a total of 36 BCVIs, of whom two had anterior and 4 posterior circulation strokes. Most of the BCVIs (n = 32) were in the vertebral arteries. Injuries were graded according to the Biffl scale: 17 grade II, 4 grade III, 14 grade IV, and 1 grade V. A ground-level fall was the most common trauma mechanism. Cervical spine fracture was the only statistically significant predictor for BCVI (OR 7.44). Degenerative spondylosis was the most prevalent etiology for ankylosis.
CONCLUSION
Ankylosis of the cervical spine increases the incidence of BCVI up to sevenfold compared to general blunt trauma populations, affecting especially the vertebral arteries.
Topics: Ankylosis; Cerebrovascular Trauma; Cervical Vertebrae; Computed Tomography Angiography; Humans; Incidence; Neck Injuries; Retrospective Studies; Spinal Fractures; Stroke; Wounds, Nonpenetrating
PubMed: 35296926
DOI: 10.1007/s10140-022-02022-8 -
Rheumatology (Oxford, England) Nov 2022In radiographic axial spondyloarthritis (r-axSpA), spinal damage manifests as syndesmophytes and facet joint ankylosis (FJA). We evaluated whether the presence of one...
OBJECTIVES
In radiographic axial spondyloarthritis (r-axSpA), spinal damage manifests as syndesmophytes and facet joint ankylosis (FJA). We evaluated whether the presence of one lesion increased the risk of the other lesion.
METHODS
Patients with r-axSpA underwent low-dose CT (ldCT) and MRI of the whole spine at baseline and 2 years. On ldCT, vertebrae were scored for presence and size of syndesmophytes; facet joints were assessed for ankylosis. MR images were assessed for inflammation. Two hypotheses were tested: (i) presence of FJA is associated with new syndesmophyte(s) on the same vertebral unit (VU) 2 years later, and (ii) presence of bridging syndesmophyte(s) is associated with new FJA on the same VU 2 years later. Two generalized estimating equations models were tested per hypothesis using increase of FJA/syndesmophytes (model A) or presence of FJA/syndesmophytes (model B) as outcome, adjusted for inflammation at baseline. Secondary analyses tested the hypotheses with outcomes on adjacent VUs and dose-response effects.
RESULTS
Fifty-one patients were included (mean age 49, 84% male, 82% HLA-B27+). Baseline bridging syndesmophytes occurred more often (range: 10-60% per VU) than FJA (range: 8-36%). Odds ratios (ORs) (95% CI) for presence of bridging syndesmophytes on development of FJA were 3.55 (2.03, 6.21) for model A and 3.30 (2.14, 5.09) for model B. ORs for presence of baseline FJA on new syndesmophytes were 1.87 (1.20, 2.92) for model A and 1.69 (0.88, 3.22) for model B. Secondary analyses yielded positive ORs for both hypotheses.
CONCLUSIONS
Bone formation in vertebrae and in facet joints influence each other's occurrence, with the effect of syndesmophytes being larger than that of FJA.
Topics: Humans; Male; Middle Aged; Female; Zygapophyseal Joint; Spondylitis, Ankylosing; Axial Spondyloarthritis; Spondylarthropathies; Spine; Tomography, X-Ray Computed; Inflammation
PubMed: 35302592
DOI: 10.1093/rheumatology/keac176 -
BMJ Case Reports Nov 2021Pseudoankylosis is a rare condition that causes inability to open the mouth due to condition related to outside of the temporomandibular joint. Most literature refers to...
Pseudoankylosis is a rare condition that causes inability to open the mouth due to condition related to outside of the temporomandibular joint. Most literature refers to this hypomobility disorder, a result of fusion of the zygomatic bone to the coronoid process, and very rarely is insidious coronoid hyperplasia causing mechanical interference with the posterior maxilla has been reported. We present a case of a 45-year-old woman, who presented with coronoid malformation and overgrowth resulting in progressive decrease in mouth opening. She was managed with coronoidectomy, following which good mouth opening was obtained. In this paper we discuss about the diagnosis and management of this rare disorder.
Topics: Ankylosis; Female; Humans; Mandible; Middle Aged; Mouth; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 34844960
DOI: 10.1136/bcr-2021-244616 -
Head & Face Medicine Oct 2023The aim of this study is to evaluate the changes in the temporomandibular joint (TMJ) in patients with temporomandibular disorder (TMD) and the relationship between age,...
BACKGROUND AND AIM
The aim of this study is to evaluate the changes in the temporomandibular joint (TMJ) in patients with temporomandibular disorder (TMD) and the relationship between age, sex, and types of TMJ change using Cone Beam Computed Tomography (CBCT).
METHODS AND MATERIAL
CBCT records of 200 patients (123 women and 67 men) were retrieved and assessed. Right and left TMJs were evaluated separately, resulting in a total of 400 TMJs. The images were analyzed using On demand 3D Application The radiographic findings were classified as erosion, proliferative changes mainly, including flattening and osteophytes of the condyle, sclerosis, Ely cyst, hypoplasia and hyperplasia of the condyles, ankylosis, and joint cavity. Data analysis was performed using descriptive statistics, paired T-tests, and repeated measure ANOVA (Analysis of Variance) in SPSS Software.
RESULTS
The most prevalent types of condylar bony changes observed was osteophyte (63.5%) followed by flattening of the articular surface (42%), erosion (40%), ankylosis (10%) and sclerosis (10%). 7.5% of joints showed hyperplastic condyles but only 2% showed hypoplasia. The least prevalent change observed was Ely Cyst (1%). Osteophyte was the most prevalent change observed in all age groups and both sexes except for men aged 31 ~ 50, where flattening was more frequent. A statistically significant difference was found between sex and prevalence of erosion in the age group of 10 ~ 30 (P = 0.001); as well as between sex and condylar hyperplasia in the same age group.
CONCLUSION
Based on the findings of this research, the prevalence of bony changes of TMJ from highest to lowest is as follows: osteophyte, flattening of the articular surface, erosion, ankylosis, sclerosis, hyperplastic condyles, hypoplastic condyles and Ely Cyst. CBCT is an accurate 3 dimensional imaging modality for assessment of TMJ bony structures.
Topics: Male; Humans; Female; Child; Cross-Sectional Studies; Osteophyte; Hyperplasia; Sclerosis; Osteoarthritis; Tooth Ankylosis; Temporomandibular Joint; Cone-Beam Computed Tomography; Cysts; Ankylosis; Mandibular Condyle
PubMed: 37898789
DOI: 10.1186/s13005-023-00392-z -
Anaesthesia May 2009Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory... (Review)
Review
Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory complications, and the medications used to reduce pain and control the disease. There is also an increased risk of neurological complications in the peri-operative period. Awake fibreoptic intubation is the safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway. Neurophysiological monitoring (somatosensory and motor evoked potentials) should be considered in patients undergoing surgery for cervical spine deformity. The medical management of the disease has improved with the use of anti-tumour necrosis factor-alpha agents. There is potential for increased wound infection in patients taking these drugs. This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken.
Topics: Adult; Anesthesia; Antirheumatic Agents; Female; Humans; Intubation, Intratracheal; Male; Spondylitis, Ankylosing; Tumor Necrosis Factor-alpha; Young Adult
PubMed: 19413825
DOI: 10.1111/j.1365-2044.2008.05794.x -
Arthritis Research & Therapy Mar 2020Little is known about the mechanisms underlying the clinical overlap between gut inflammation and joint ankylosis, as exemplified by the concurrence of inflammatory...
BACKGROUND
Little is known about the mechanisms underlying the clinical overlap between gut inflammation and joint ankylosis, as exemplified by the concurrence of inflammatory bowel diseases (IBD) and ankylosing spondylitis (AS). As dysbiosis may serve as a common contributor, the anti-microbial pleiotropic factor lipocalin 2 could be a potential mediator due to its roles in inflammation and bone homeostasis.
METHODS
Baseline colonic pathology was conducted in the ank/ank mouse model. Serum lipocalin 2 was analyzed by ELISA, in ank/ank mutants versus C3FeB6-A/Awt/wt, in patients with concurrent AS-IBD, AS alone, IBD alone, or mechanical back pain, and in healthy controls. In the ank/ank mouse model, the expression of nuclear receptor peroxisome proliferator-activated receptor gamma (PPARγ) was examined by real-time PCR. Intraperitoneal injection was done with the PPARγ agonist rosiglitazone or antagonist bisphenol A diglycidyl ether for four consecutive days. Serum levels of lipocalin 2 were examined on the sixth day.
RESULTS
This study showed that the ank/ank mice with fully fused spines had concurrent colonic inflammation. By first using the ank/ank mouse model with progressive ankylosis and subclinical colonic inflammation, confirmed in patients with concurrent AS and IBD, elevated circulating lipocalin 2 levels were associated with the coexisting ankylosis and gut inflammation. The intracellular pathway of lipocalin 2 was further investigated with the ank/ank mouse model involving PPARγ. Colonic expression of PPARγ was negatively associated with the degree of gut inflammation. The PPARγ agonist rosiglitazone treatment significantly upregulated the serum levels of lipocalin 2, suggesting a potential regulatory role of PPARγ in the aberrant expression of lipocalin 2.
CONCLUSIONS
In summary, lipocalin 2 modulated by PPARγ could be a potential pathway involved in concurrent inflammation and ankylosis in AS and IBD.
Topics: Animals; Ankylosis; Disease Models, Animal; Female; Humans; Inflammation; Inflammatory Bowel Diseases; Lipocalin-2; Male; Mice, Knockout; PPAR gamma; Rosiglitazone; Spondylitis, Ankylosing; Up-Regulation
PubMed: 32188494
DOI: 10.1186/s13075-020-02149-4 -
JMIR MHealth and UHealth Jul 2021Patients with ankylosing spondylitis (AS), a chronic systematic inflammatory disease, require long-term treatment and management. Mobile health (mHealth) apps can...
BACKGROUND
Patients with ankylosing spondylitis (AS), a chronic systematic inflammatory disease, require long-term treatment and management. Mobile health (mHealth) apps can deliver health services through mobile devices, facilitate long-term disease management, support patient-health care provider communication, and enable patients to engage in disease management. There are some apps targeted at patients with AS, but the feature and quality of these apps have not been systematically examined.
OBJECTIVE
The aim of this study was to identify existing, publicly available Chinese mHealth apps for AS management and to evaluate their features and quality.
METHODS
We systematically searched potential apps for AS management on the Apple and Huawei App Stores, using 4 search terms: ankylosing spondylitis, spondyloarthritis, rheumatic disease, and arthritis. Apps were included if they were in the Chinese language, targeted at patients with AS, could be downloaded and run on Android and/or iOS operating systems, and incorporated elements of disease management and/or patient education. We excluded apps that were not for patient use, not relevant to AS, or had not been updated since 2018. Apps that met the inclusion criteria were downloaded for final analysis. We formulated a list of app quality measures from and consistent with international guidelines for mHealth apps and AS management to evaluate the features and quality of the included app. The user version of the Mobile App Rating Scale (uMARS) was also used to rate the apps' quality.
RESULTS
Of the 354 apps screened, 5 met the inclusion criteria and were included in our analysis. All apps were free, and most apps (4/5, 80%) had a privacy policy. Of the 5 apps, 1 (20%) involved medical professionals in the development process, 2 (40%) were developed by companies, and 2 (40%) were developed by medical institutions. All apps provided educational information about AS. Around half of the apps had functions like a basic information record (ie, users can input gender, age, disease history, etc) (n=3, 60%), patient-health care provider (and patient-patient) communication (n=2, 40%), symptom tracking (n=2, 40%), and information sharing (n=3, 60%). Only 1 (20%) app provided comprehensive functions that adhered to international guidelines for AS management and mHealth apps. The overall uMARS scores ranged from 2.7 to 4.2; only 1 app, with an overall uMARS score of 4.2, was considered as a high-quality app.
CONCLUSIONS
Most apps lacked comprehensive functions for AS management. One high-quality app provided comprehensive functions to help patients manage their conditions. This study assessed and summarized the features and quality of the apps but did not evaluate their efficacy. Future studies should evaluate the feasibility and efficacy of these apps. International guidelines and regulations for the design, development, validation, and implementation of mHealth apps are needed in the future. Meanwhile, health care providers, patients with AS, and app developers should collaborate to develop high-quality, evidence-based apps that take into account patients' needs and health care professionals' perspectives.
Topics: China; Humans; Language; Mobile Applications; Spondylitis, Ankylosing; Telemedicine
PubMed: 34259644
DOI: 10.2196/27234 -
European Radiology Dec 2023To determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal...
OBJECTIVES
To determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH).
MATERIALS AND METHODS
A retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports.
RESULTS
Of 70 post-traumatic patients (54 men, median age 73, IQR 66-81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI.
CONCLUSIONS
SEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression.
CLINICAL RELEVANCE STATEMENT
Low-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation.
KEY POINTS
• Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH. • Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma. • Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.
Topics: Male; Humans; Aged; Hyperostosis, Diffuse Idiopathic Skeletal; Hematoma, Epidural, Spinal; Spine; Spinal Fractures; Fractures, Bone; Ankylosis
PubMed: 37382616
DOI: 10.1007/s00330-023-09866-9 -
BMJ Case Reports Sep 2021Osteomas are benign tumours of bone tissue restricted to the craniofacial skeleton. The aim of this article is to present and discuss the demographic and clinical...
Osteomas are benign tumours of bone tissue restricted to the craniofacial skeleton. The aim of this article is to present and discuss the demographic and clinical aspects and the management of craniomaxillofacial osteomas. When the patient was submitted from primary care to our hospital, he was 68 years old, and he had ankylosis of the temporomandibular joint for the previos 4 years. A CT scan was performed, finding a giant mandibular osteoma. Conservative treatment and radiological follow-up were carried out with clinical stability. Osteomas more often are seen in the paranasal sinuses and in young adults, with no differences in gender. Most are asymptomatic, but they can cause local problems. For its diagnosis, CT is usually performed. Treatment options are conservative management and follow-up or surgery. Although rarely, they can recur. Mandibular peripheral osteoma is a rare entity. Depending on the symptoms, a conservative or surgical treatment can be chosen. A clinical and radiological follow-up is necessary to detect possible recurrences or enlargement.
Topics: Aged; Ankylosis; Humans; Male; Neoplasm Recurrence, Local; Osteoma; Paranasal Sinuses; Trismus; Young Adult
PubMed: 34551913
DOI: 10.1136/bcr-2021-244014 -
Annals of the Rheumatic Diseases Dec 2002Patients with ankylosing spondylitis (AS) are characterised by a wide range of clinical presentations, radiographic profiles, and outcomes, which are not well... (Review)
Review
Patients with ankylosing spondylitis (AS) are characterised by a wide range of clinical presentations, radiographic profiles, and outcomes, which are not well differentiated by current diagnostic and classification systems for the disorder. Inadequacies in these systems may limit clinicians' ability to manage their patients with AS appropriately and act as an obstacle to reasonable comparison of therapeutic trial results. A standardised staging system for AS is therefore proposed that would provide a more detailed categorisation of patients based on assessment of structural damage, peripheral joint and organ involvement, presence of concomitant diseases, and the severity and extent of disease activity and functional impairment. The proposed system needs to be evaluated closely and amended as needed to assure its usefulness in clinical and research settings.
Topics: Anti-Inflammatory Agents; Humans; Prognosis; Severity of Illness Index; Spondylarthropathies; Spondylitis, Ankylosing
PubMed: 12381507
DOI: 10.1136/ard.61.suppl_3.iii19