Surgical management of spinal fractures in ankylosing spondylitis: A case series and literature review

Abstract

Ankylosing spondylitis is a common disorder affecting 2 per 1000 individuals in the population. The hallmark finding is sacroiliitis with a variable degree of ascending spinal column involvement. Spinal fractures are a common complication and are characterized by instability, long lever arms across the fractured segment, and a high incidence of neurological injury. We describe a case series of three patients with ankylosing spondylitis, who incurred typical spinal fractures seen in these patients, and presented to our unit over a three-year period. Our management highlights several
of the important principles that should be employed. We further reviewed the literature on the subject and provide a review of current thinking on the subject. Spinal fractures in patients with ankylosing spondylitis most commonly occur in the subaxial cervical spine and at the thoracolumbar junction. Conservative management is fraught with a high complication rates which includes pneumonia and secondary neurological injury and several studies recognize the advantages of early instrumented fixation and mobilization. As such these fractures are best managed surgically and
there is a global trend towards this as the standard of care. A high incidence of neurological injury dictates early operative intervention to relieve compression and correct deformity and the prevention of secondary neurological injury is the fundamental aim of surgery. Appreciating the nuances in the management of patients with ankylosing spondylitis who incur spinal fractures is essential to ensure an optimal neurological outcome. We provide a case series and literature review to provide spinal surgeons with an understanding of the specific considerations that should be employed, and thereby assist those who manage these patients.

Key words: Ankylosing spondylitis spinal fracture, Ankylosing spondylitis cervical fracture, Ankylosing spondylitis thoracolumbar fracture