Spinal fractures in ankylosing spondylitis: prevalence, prevention and management

Abstract

In patients with ankylosing spondylitis (AS), the risk of vertebral fractures (VFs) is increased. Case finding and fractures in patients with AS is a clinical challenge for several reasons. First, back pain and hyperkyphosis are mostly attributed to disease-related inflammation and structural damage in terms of erosions and syndesmophytes, and not to an eventual VF. Second, the most frequent VFs are classical wedging, biconcave or crush VFs as seen in postmenopausal women and the elderly, but once multilevel ankylosis of the spine is manifested, fractures can also occur in other parts and directions of the vertebrae (transvertebral, in the dorsal arch structures and through the ankylosed extravertebral calcifications of ligaments and intervertebral discs) and in the cervical spine. Diagnosis of these atypical fractures is much more difficult. Besides the pathology of fractures in general in patients with AS, VFs are associated with hyperkyphosis of the spine and can result in irreversible neurological com...