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Cervical spine ankylosis — Clinical Guidelines

Overview

Cervical spine ankylosis refers to the abnormal fusion of vertebrae in the cervical region, often resulting from trauma, infection, or degenerative conditions, leading to limited neck mobility and potential neurological complications. 1 2 4

Diagnosis

Clinical Presentation: Neck pain, limited range of motion, and neurological deficits depending on severity.

Imaging Studies: CT and MRI are crucial for visualizing bony fusion and soft tissue involvement. 1 4

Grading: Often assessed based on the extent of fusion and associated neurological impairment, though specific grading systems are not detailed in provided abstracts. 3

Management

Surgical Interventions: Anterior and posterior approaches for decompression and stabilization, particularly in cases of instability or metastatic disease. 3 4

Endovascular Techniques: Covered stents for managing iatrogenic vertebral artery injuries during surgery. 2

Conservative Management: Physical therapy and pain management for less severe cases, though efficacy varies. 1

Anesthesia Considerations: Use of laryngeal mask airway in neutral position for patients with cervical spine instability to minimize movement risks. 7

Special Populations

Elderly: Surgical risks and complications are higher; outcomes often depend on comorbidities and life expectancy. 3

Comorbidities: Chronic conditions like COPD and diabetes mellitus can complicate surgical planning and recovery. 4

Key Recommendations

Utilize imaging (CT, MRI) for definitive diagnosis of cervical spine ankylosis and associated complications. (Evidence: Moderate 1 4)

Consider surgical intervention (anterior/posterior approaches) for patients with significant instability or metastatic involvement, especially in specialized units. (Evidence: Moderate 3 4)

Employ endovascular techniques like covered stents for managing vascular injuries during cervical spine surgeries to ensure procedural continuity. (Evidence: Weak 2)

For patients with cervical spine instability, the laryngeal mask airway in neutral head position can be a viable alternative to tracheal intubation to avoid exacerbating spinal injuries. (Evidence: Expert opinion 7)

References

1 Grant A, Stuttard M, Mitchell T. Brief teaching sessions change behaviour in A&E. The clinical teacher 2019. link 2 Wangqin R, Xu K, Mokin M, Uribe J, Rojas H, Ren Z. Covered Stent to Salvage Iatrogenic Vertebral Artery Injury with Uncontrolled Bleeding in the Operating Room Setting. World neurosurgery 2019. link 3 Vazifehdan F, Karantzoulis VG, Igoumenou VG. Surgical treatment for metastases of the cervical spine. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2017. link 4 Zwolak P, Kröber M. Acute neck pain caused by atlanto-axial instability secondary to pathologic fracture involving odontoid process and C2 vertebral body: treatment with radiofrequency thermoablation, cement augmentation and odontoid screw fixation. Archives of orthopaedic and trauma surgery 2015. link 5 Girard V, Leroux B, Brun V, Bressy G, Sesmat H, Madi K. Post-traumatic lower cervical spine instability: arthrodesis clinical and radiological outcomes at 5 years. Orthopaedics & traumatology, surgery & research : OTSR 2014. link 6 Song JW, Kwak YL, Lee JW, Chang CH, Kim HS, Shim YH. The optimal effect site concentration of remifentanil in combination with intravenous midazolam and topical lidocaine for awake fibreoptic nasotracheal intubation in patients undergoing cervical spine surgery. Minerva anestesiologica 2012. link 7 Brimacombe J, Berry A. Laryngeal mask airway insertion. A comparison of the standard versus neutral position in normal patients with a view to its use in cervical spine instability. Anaesthesia 1993. link

Cervical spine ankylosis