Surgical treatment of vertebral fractures in patients with ankylosing spondylitis: a retrospective study

Abstract

Background: The diagnosis of vertebral fractures in patients with ankylosing spondylitis is sometimes difficult and management should respect the nature of the disease and patient’s deformity. We aim to clarify some technical steps during diagnosis and management and analyze the possible complications. Methods: Twenty-two patients were enrolled in this study between January 2004 and December 2014. All patients were already diagnosed with ankylosing spondylitis (AS) and presented with vertebral column fractures. All patients were men with an average age of 55.9 yr. Six patients had a fractured cervical spine, one patient had a cervicodorsal junction fracture, seven had a fractured dorsal spine, and eight had dorsolumbar junction fractures. The patients were evaluated neurologically according to Frankel grading system. All patients had radiographic survey of the entire spine. CT was obtained in every patient. MRI was obtained to evaluate the neural tissues and presence of epidural hematoma. All patients required surgery to stabilize the vertebral column. Long fixation with adequate bone graft is the rule for dorsal and dorsolumbar fractures with respect to the preoperative deformity. Anterior fixation and posterior fixation were done for cervical fractures extending to more than one level. Results: All patients with cervical fractures had anterior fixation followed by posterior laminectomy and lateral mass fixation. No anterior approach or fixation was done for dorsal or dorsolumbar fractures. Five patients were admitted to the intensive care unit postoperatively. The mean follow-up period was 24.5 mo. The patients who were Frankel E postoperatively regained their preoperative level of activity. At the end of follow-up, there were no metal failures or pseudoarthrosis. Conclusions: The surgical treatment is a cornerstone with attention to the nature of the disease and the preexisting deformity of the patient.