Posterior pedicle screw fixation to treat lower cervical fractures associated with ankylosing spondylitis: a retrospective study of 35 cases

Zhenguo Luo,Baorong He,Dingjun Hao,Liang Yan,Jijun Liu

doi:10.1186/s12891-017-1396-5

Zhenguo Luo, Baorong He + Show 3 more

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https://doi.org/10.1186/s12891-017-1396-5

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Abstract

BackgroundThe most common site of fractures in patients with ankylosing spondylitis (AS) is the cervical spine, especially the lower cervical spine and cervicothoracic junction. The optimal treatment for cervical spine fractures secondary to AS is controversial. This study aimed to explore the effects of posterior pedicle screw fixation alone on fractures of the lower cervical spine in patients with AS.MethodsFrom January 2006 to January 2013, a total of 35 patients with AS and a lower cervical spine fracture were treated using only posterior cervical/thoracic pedicle screw fixation. In this retrospective study, we reviewed the patients’ charts to assess their case histories, operations, neurological outcomes, and complications. We also evaluated their postoperative radiographs to determine the time of bone fusion.ResultsAltogether, 32 (91.4%) of the 35 fractures resulted from an acute injury and 3 (8.6%) from a chronic injury. In 25 cases, the fracture resulted from a low-energy spinal injury and in 8 cases from a high-energy injury. Posterior pedicle screw fixation was successful in all patients, with radiographic fusion confirmed by computed tomography. The average time of bone fusion was 3.6 months (range 3 − 6 months). The surgery improved the American Spinal Injury Association grade in 15 (42.9%) patients. No intraoperative complications occurred. None of the corrections resulted in neurological decompensation. The average postoperative correction was 18°.ConclusionsPedicle screw fixation and autologous bone grafting through a single posterior approach to lower cervical spine fractures in AS patients could stabilize the spine, correct kyphosis, and relieve pressure. It is thus reasonable to recommend this surgical strategy for AS-associated fractures of the lower cervical spine.Trial registrationNot applicable.

Highlights

The most common site of fractures in patients with ankylosing spondylitis (AS) is the cervical spine, especially the lower cervical spine and cervicothoracic junction
The aim of this study was to show the surgical experience of treating lower cervical spine fractures in patients with AS using posterior pedicle screw fixation alone
Patient population The study is based on data from patients with AS and lower cervical spine fractures who underwent posterior cervical/thoracic pedicle screw fixation between 2006 and 2013

Summary

Introduction

The most common site of fractures in patients with ankylosing spondylitis (AS) is the cervical spine, especially the lower cervical spine and cervicothoracic junction. This study aimed to explore the effects of posterior pedicle screw fixation alone on fractures of the lower cervical spine in patients with AS. Ankylosing spondylitis (AS) is a seronegative, progressive, systemic, inflammatory, rheumatic spondyloarthropathy that mainly affects the spine and sacroiliac joints [1]. The condition is associated with progressive ossification of the spinal ligaments and ankylosis of the facet joints, eventually leading to a completely stiff spine. Calcification of the longitudinal ligaments eventually results in the classic radiographic “bamboo spine” appearance. The creation of a rigid spinal column, with associated osteoporosis as the disease progresses, results in a brittle, rigid structure that is poorly suited to withstand stress. Even minor trauma can result in a fracture [2,3,4,5]

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