Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation.

Abstract

Introduction of a posterior approach for internal fixation of fractures of the ankylosed cervical spine. To evaluate the clinical outcome of patients with ankylosing spondylitis and cervical spinal fractures treated with posterior instrumentation and a collar orthosis. Cervical spinal fractures in patients with ankylosing spondylitis almost always extend completely across the vertebral segment to include both anterior and posterior elements. Treatment with immobilization alone is often inadequate. Generalized spinal rigidity and exaggerated thoracic kyphosis may hinder anterior exposure. Posterior approaches have been described but generally require postoperative halo immobilization. In the authors' technique for patients whose spinal alignment is relatively well preserved, a posterior exposure is used that achieves three-point internal fixation along multiple segments. The complications associated with halo immobilization are avoided. Seven patients with ankylosing spondylitis and fractures of the cervical spine were stabilized with posterior instrumentation. Patients were immobilized after surgery with either a cervical collar or a sternal occipital mandibular immobilizing brace and observed for neurologic outcome, radiographic evidence of bony fusion, and complications. No patient experienced neurologic deterioration with surgery. Two patients died at acute rehabilitative facilities after discharge. Radiographic evidence of fusion was observed in the five patients available for follow-up. Patients with ankylosing spondylitis and cervical spinal fractures can be adequately treated with lateral mass plating and interspinous wiring of autologous rib graft. Adequate postoperative immobilization can be attained with a cervical collar and does not require a halo vest.