MRI of cervical spine injuries complicating ankylosing spondylitis
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SCIENTIFIC ARTICLE
MRI of cervical spine injuries complicating ankylosing spondylitis Mika P. Koivikko & Seppo K. Koskinen
Received: 19 December 2007 / Revised: 19 February 2008 / Accepted: 25 February 2008 / Published online: 18 April 2008 # ISS 2008
Abstract Objective The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. Materials and methods A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. Results On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson’s, 1 atlas posterior arch (Jefferson’s on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. Conclusion Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained M. P. Koivikko (*) : S. K. Koskinen Töölö Hospital, Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Central Hospital, Topeliuksenkatu 5, FIN - 00029 Helsinki, Finland e-mail: [email protected]
with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis. Keywords Vertebral column . Spondylitis, ankylosing . Spinal fractures . Magnetic resonance imaging
Introduction Ankylosing spondylitis (AS, Bechterew’s disease, MarieStrümpell arthritis) is an inflammatory disease affecting primarily the sacroiliac joints and spine, but other joints as well. AS primarily affects males and is associated with the HLA allele B27, present in 14% of the Finnish population and in 8% of North Americans. The annual incidence of AS in Finland is 6.9/100,000, and the prevalence of clinically significant AS is 0.15%, although the prevalence of radiological AS is estimated at 1% [1]. In advanced disease, the onset of ankylosis and osteoporosis predisposes AS patients to spinal fractures [2]. These may result from only minor trauma, which most commonly is a simple slip or trip [3]. Due to difficult positioning, distorted anatomy, and osteoporosis, radiography is not credible in clearance of such spines [4]. Because of the high incidence of fractures, multi-detector CT (MDCT) is the prefer
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