NEUROLOGICAL COMPLICATIONS OF ANKYLOSING-SPONDYLITIS

Thirty-three patients with ankylosing spondylitis with or without spin al neurological symptoms requiring surgical intervention were identifi ed in a retrospective review of all cases of spinal disorders treated at the Mayo Clinic during the period from 1984 to 1989. Spinal fractur es (traumatic or pseudoarthroses), progressive spinal deformity, rotar y instability secondary to atlanto-occipital or atlantoaxial subluxati on, and spinal stenosis with associated neurological deficit, pain, or spinal instability were the most common indications for surgery. Of t he 41 operations performed, there were 17 cervical, 14 thoracic, and 1 0 lumbar procedures. Eight patients had two or more disorders at separ ate spinal levels that required surgery. Preoperative neurological def icits were recorded in 13 patients: these improved following surgery i n nine and stabilized in four. This review emphasizes the fragility of the ankylosed spinal column and its inherent susceptibility to fractu re with attendant neurological compromise. It also identifies the vari ety of spinal disorders observed in these patients and discusses their surgical management. The experience with this series suggests that th orough radiological evaluation, extreme caution with endotracheal intu bation and with halo-vest applications, early surgical spinal immobili zation, and aggressive postoperative mobilization of patients are nece ssary for a successful outcome. It is concluded that outcomes in these patients can be favorable when managed appropriately.