Ankilozan spondilit/DISH zemininde servikal kırık

Özet

Ankilozan spondilit veya diffüz idiopatik iskelet hiperostozunda füzyona uğramış servikal omurga uzun kaldıraç kolu gibi davranır ve görece küçük travmada bile kırılabilir. Kırık çoğu kez ankiloz köprüsünü, diski veya korpusu ve posterior elemanları birlikte geçen uzun bir hatta uzanır. İnce kesit BT kırık hattının seviyesini ve üç boyutlu yayılımını gösterirken, tek bir servikal odakla yetinmek eşlik eden başka omurga kırıklarını kaçırabilir. Az deplase kırıkta bile ciddi nörolojik kötüleşme ve gecikmiş tanı riski bulunduğundan görüntülerin tamamı dikkatle taranmalıdır.

Faz ve pencere

Kontrastsız tanısal

Ankiloz köprüleri veya füzyonlu disk aralığı boyunca keskin radyolüsent kırık hattı, kortikal basamak, vertebra translasyonu ve paravertebral hematom aranır; intravenöz kontrast kemik kırığını göstermede gerekmez.

Kemik algoritması tanısal

Sagittal ve koronal ince kesit rekonstrüksiyonları anterior kemik köprüsünden korpus ve posterior elemanlara uzanan kırık hattını, aksiyel kesitler ise faset ve kanal bileşenini gösterir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Ankiloz köprüsü kesintisi — vertebra ön yüzü boyunca uzanan sindesmofit veya DISH köprüsünde akut, keskin hat görülür.
• Transdiskal geçiş — kırık hattı kaynaşmış ya da daralmış disk aralığını keserek komşu korpusa ulaşır.
• Transvertebral devamlılık — kırık korpusun ön ve arka korteksinden geçip posterior elemanlara uzanabilir.
• Üç kolonlu örüntü — anterior kolonla birlikte korpusun posterior duvarı, pedikül, lamina veya faset bileşenleri de etkilenir.
• Küçük yer değiştirme — ince kırık çizgisi belirgin basamak oluşturmadan ankiloze segmenti çaprazlayabilir.
• Segmental açılanma — kırık seviyesinde yeni kifoz veya translasyon rijit omurga konturunu kesintiye uğratır.
• Eşlik eden kırık odağı — uzun kemikleşmiş omurga boyunca ayrı bir düzeyde ikinci kırık hattı bulunabilir.

Normalde

Kırık olmayan ankiloze servikal omurgada köprüleşmiş sindesmofitler kesintisiz, vertebra kenarları ise kırık basamağı olmadan aynı kemik konturu boyunca izlenir. Şüpheli hattı bitişik kemik köprüleri ve posterior elemanlarla karşılaştırın; yeni kortikal kesinti, hizalanma değişikliği ve hattın kanal arkasına uzanıp uzanmadığına bakın.

Ayırıcı tanı

Kronik psödoartroz

ankilozan spondilitli hastalarda vertebra kırığı sonrası gelişebilir; intravertebral vakum fenomeni psödoartroz ve kemik kaynamamasına işaret edebilir.

Osteoporotik kompresyon

ankilozan spondilitli hastalarda kompresyon kırığı görülebilir; bir seride 70 hastanın yalnız birinde kompresyon kırığı, 69 hastada ise üç kolonu tutan transvers kırıklar bildirilmiştir.

Eski stabil füzyon

BT'de solid kemik füzyonu görülebilir.

Tuzaklar

• Deplasmanı az olan çizgiyi önemsiz sayma; ankiloze omurgada uzun kaldıraç etkisi küçük hareketle bile instabil kırık oluşturabilir.
• Yalnız semptom düzeyini görüntüleyip incelemeyi bitirme; ankiloze omurganın servikal, torakal ve lomber kesimlerinde başka kırık odağı da bulunabilir.
• Kemikleşmiş anterior ligament çizgisindeki kesintiyi normal varyant sanma; hattın disk veya korpus içinden posterior elemanlara devamını rekonstrüksiyonlarda izle.

Kendini dene

1. Ankilozan servikal omurgada küçük travma sonrası ince hat sindesmofiti, C6 korpusunu ve laminaları kesiyor. En olası tanı nedir?

   • Ankilozlu omurga kırığı
   • Kronik psödoartroz
   • DISH varyantı
   • Osteoporotik kama kırığı
   Cevabı göster

   Ankilozlu omurga kırığı. Keskin yeni hattın köprü, korpus ve posterior elemanları geçmesi travmatik kırık ve çok kolonlu yayılımı gösterir. Ankilozan spondilitli omurga, küçük travma sonrası bile kırılabilir ve bu kırıklar sıklıkla instabildir.

2. Boyun ağrısı tariflenen hastanın servikal BT'sinde tek kırık saptandı. Ankiloze omurgada ek olarak hangi alanı taramak gerekir?

   • Tüm omurga
   • Yalnız kafa tabanı
   • Sadece toraks girişi
   • Yalnız pelvis
   Cevabı göster

   Tüm omurga. Ankilozlu omurgada eşzamanlı veya klinik olarak uzak başka seviyede kırık bulunabileceğinden tüm omurga boyunca tarama gerekir. Kafa tabanı, toraks girişi veya pelvis tek başına yeterli anatomik kapsam sağlamaz.

İlgili konular

• Travmatik kemik kanal basısı
• Diskoligamentöz yaralanma (BT dolaylı bulguları)

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 3 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.