Fresh fracture of the cervical spine in ankylosing spondylitis: clinical characteristics and surgical strategy

English Keywords:Ankylosing spondylitis  Cervical spine fracture  Surgical strategy

English Abstract:

  【Abstract】 Objectives: To explore the clinical features and the optimal surgical strategies of the cervical spine fresh fracture complicated with ankylosing spondylitis(AS). Methods: Between February 2002 and October 2014, 15 AS patients with concomitant fresh fracture of the cervical spine treated in our institution were included in this study. There were 14 males and 1 female with a mean age of 49.7±10.8 years(range, 36-76 years). Among them 13 cases with trauma history, only 4 cases sustained high energy injury. Most fractures located at C5-C7(14 cases), 8 transvertebral and 7 transdiscal injuries were noted. Neurological compromise accounted for 12(80%) cases. 12 patients received surgical treatment, consisting anterior discectomy/corpectomy and fusion in 7 cases, posterior long-segment fixation and fusion in 3 cases, and combined anterior and posterior approach in 2 cases. Pre- and post-operative neurologic functions were evaluated by ASIA grade, and fusion rate was assessed by X-ray during follow-up. Results: Except that 3 patients did not undertake surgical treatment, all the other patients were followed up for an average of 20.0±18.8 months(range, 3-60 months). Except for 1 ASIA grade A and 2 ASIA grade D patients, neurological function improved significantly after surgery. Solid fusion was observed in all patients at final follow-up. Perioperative complications included postoperative cerebrospinal fluid leakage in 1 case, recurrent nerve injury in 1 case and deep wound infection following anterior approach in 1 case. No nonunion, pseudarthrosis or implant failure was noted. Conclusions: Subaxial cervical spine injury is common in AS patients, and the three-column involvement makes the fracture extremely unstable which may often lead to neurological deficits. Anterior stabilization is effective in those with obvious anterior column defects. For AS patients with sufficiently stable anterior column, posterior fixation should be adopted. And a combined anterior-posterior approach should be applied for severe fracture-dislocation of the cervical spine.