title: Intraoperative myelography of traumatic spine injury in patients with ankylosing spondylitis. Technical note.
abstract: 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, and high morbidity and mortality. Diagnostics rely 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 is not possible for several reasons.
  
  
  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 or hemorrhages in the thoracic spine and in addition a standard myelography could not be performed due to ossifications of ligaments. As an alternative, we performed an intra-operative myeolgraphy. Intra-operative installation of a lumbar drain made a myelography and post-myelographic CT scan feasible.
  
  
  RESULTS
  The scan revealed a contrast stop at T-10 and subsequently operative decompression and evacuation of the hematoma were performed.
  
  
  CONCLUSIONS
  We present a quick and safe 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.
authors.affiliation: Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer Campus 1, Gebäude A1, 48127, Münster, Germany. michael.schwake@ukmuenster.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwake
authors.affiliation: Institute of Clinical Radiology, University Hospital Münster, Münster, Germany.
authors.forename: Tarek
authors.initials: T
authors.lastname: Zoubi
authors.affiliation: Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer Campus 1, Gebäude A1, 48127, Münster, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schipmann
authors.affiliation: Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer Campus 1, Gebäude A1, 48127, Münster, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
authors.affiliation: Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer Campus 1, Gebäude A1, 48127, Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ewelt
mesh_terms: D000058:Accidental Falls; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D019299:Decompression, Surgical; D006801:Humans; D008297:Male; D009192:Myelography / Q000379:methods*; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome
keywords: Ankylosing spondylitis; Intra-operative imaging; Myelography; Trauma