Aims

The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs.

Purpose. Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine injury following relatively minor trauma. The authors present a retrospective review to determine the characteristics, treatment and outcome following cervical spine injury in these patients. Methods. Retrospective analysis of case notes and images of patients with AS admitted to the Spinal Injury Unit over a 10-year period. Results. Thirty-nine patients were identified. Records were available for 31 patients at the time of this analysis. The median age was 62 years (range 37-84). The male:female ratio was 7:1. Mechanisms of injury included falls (72%) and RTAs (7%), while 14% were unable to recall an injury. Alcohol was involved in 20% of the cases. Fracture through an ankylosed disc in the mid to low cervical spine was the commonest injury. Concomitant non-contiguous bony injury was seen in 2 patients. More than half (55%) were Grade E on ASIA impairment scale (AIS), while 14% were Grade A and 31% Grade D. Two patients required skull traction. Most patients were successfully treated by external immobilisation. Halo crown and jacket was the most common orthosis used. Twelve patients underwent surgical stabilisation. The mean duration of external immobilisation in the non-surgical group was 13 weeks (range 10-32), whereas following surgery it was 6 weeks (range 2-8). Adequate radiological evidence of fusion was seen in all 22 patients for whom this information was available at a median of 22 weeks (range 12-32). Patients with AIS Grade A and E were unchanged at discharge, while 4 patients in AIS Grade D improved to E. Conclusion. External immobilisation with halo in an effective first-line therapy in achieving fusion and stability. Surgical stabilisation can be reserved as a second-line treatment

Purpose. Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine injury following relatively minor trauma. The authors present a retrospective review to determine the characteristics, treatment and outcome following cervical spine injury in these patients. Methods. Retrospective analysis of case notes and images of patients with AS admitted to the Spinal Injury Unit over a 10-year period. Results. Thirty-nine patients were identified. Records were available for 31 patients at the time of this analysis. The median age was 62 years (range 37-84). The male:female ratio was 7:1. Mechanisms of injury included falls (72%) and RTAs (7%), while 14% were unable to recall an injury. Alcohol was involved in 20% of the cases. Fracture through an ankylosed disc in the mid to low cervical spine was the commonest injury. Concomitant non-contiguous bony injury was seen in 2 patients. More than half (55%) were Grade E on ASIA impairment scale (AIS), while 14% were Grade A and 31% Grade D. Two patients required skull traction. Most patients were successfully treated by external immobilisation. Halo crown and jacket was the most common orthosis used. Twelve patients underwent surgical stabilisation. The mean duration of external immobilisation in the non-surgical group was 13 weeks (range 10-32), whereas following surgery it was 6 weeks (range 2-8). Adequate radiological evidence of fusion was seen in all 22 patients for whom this information was available at a median of 22 weeks (range 12-32). Patients with AIS Grade A and E were unchanged at discharge, while 4 patients in AIS Grade D improved to E. Conclusion. External immobilisation with halo in an effective first-line therapy in achieving fusion and stability. Surgical stabilisation can be reserved as a second-line treatment

Aims

Although we often encounter patients with an aortic aneurysm who also have diffuse idiopathic skeletal hyperostosis (DISH), there are no reports to date of an association between these two conditions and the pathogenesis of DISH remains unknown. This study therefore evaluated the prevalence of DISH in patients with a thoracic aortic aneurysm (AA).

We reviewed seven children with torticollis due to refractory atlanto-axial rotatory fixation who were treated in a halo vest. Pre-operative three-dimensional CT and sagittal CT imaging showed deformity of the superior articular process of C2 in all patients. The mean duration of halo vest treatment was 67 days (46 to 91). The mean follow-up was 34 months (8 to 73); at the latest review six patients demonstrated remodelling of the deformed articular process. The other child, who had a more severe deformity, required C1-2 fusion.

We suggest that patients with atlanto-axial rotatory fixation who do not respond to conservative treatment and who have deformity of the superior articular process of C2 should undergo manipulative reduction and halo-vest fixation for two to three months to induce remodelling of the deformed superior articular process before C1-2 fusion is considered.