Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach?

Abstract

Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures. A systematic review was undertaken using the keywords 'ankylosing spondylitis', 'spine fractures', 'cervical fractures', 'surgery' and 'postoperative outcomes' on Medline, Pubmed, Google Scholar, Ovid and Embase, and the quality of the studies included was evaluated according to the Coleman Methodology Score. Surgery ameliorates neurological function in patients with unstable AS-related cervical fractures. The combined anterior/posterior and the posterior approaches are more effective than the anterior approach. The optimal approach, anterior, posterior or combined anterior/posterior, for the management of AS related cervical fractures has not been defined. Open reduction and internal fixation allows avoiding worsening and enhances neurological function in AS patients with cervical fractures. Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions.