Spine Surgery and Ankylosing Spondylitis

医学 强直性脊柱炎 骶髂关节炎 围手术期 外科 脊柱炎 气道 脊柱疾病 腰椎
作者
Andrei Fernandes Joaquim,Samuel A de Oliveira,Simone Appenzeller,Alpesh A. Patel
出处
期刊:Clinical spine surgery [Ovid Technologies (Wolters Kluwer)]
卷期号:36 (1): 8-14 被引量:5
标识
DOI:10.1097/bsd.0000000000001306
摘要

Ankylosing spondylitis (AS) is a common form of axial spondyloarthritis, characterized by inflammatory back pain, radiographic sacroiliitis, excess spinal bone formation, and a high prevalence of HLA-B27. Commonly, AS patients require spinal surgery for kyphotic deformities, spinal trauma, and spinal infections. For preoperative management, proper interruption considering each specific half-lives of disease-modifying antirheumatic drugs are necessary to avoid complications, such as infections. When feasible, bone quality assessment before surgery is mandatory. For intraoperative measurements, airway management should be carefully evaluated, especially in patients with severe cervical deformities. Cardiac, renal, and pulmonary assessment should be made considering specific pathologic characteristics involved in AS patients, such as pulmonary restrictive disease and chronic anti-inflammatory drugs use. Multimodal neurophysiological intraoperative monitoring is recommended once these patients had a high risk for neurological deterioration. At the postoperative period, early oral intake, early mobilization, and aggressive pain control may decrease complications and enhance recovery. AS presents several unique challenges that require specific attention around spine surgery. This includes handling preoperative and postoperative pharmacotherapeutics, intraoperative airway management, and the mitigation of postoperative complications. In this paper, we provide a literature review of optimal strategies for the perioperative management for patients with AS.
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