Treatment of spinal fractures in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy with the potential for progressive spinal stiffness that ultimately makes patients susceptible to spinal fractures with traumatic spinal cord injury from even low-energy trauma. Treatment of patients with AS and spinal fractures (AS+FX) is controversial because, although these patients need especially rigorous stabilization, surgery has been associated with an increased risk of complications and persistent neurological deficits. The purpose of this retrospective case series was to profile patients with AS+FX from a 19-year period within the authors' county hospital system, including differences of neurological status in patients treated operatively vs nonoperatively. The study group comprised 11 patients with AS+FX (9 men and 2 women; mean age, 63 years [range, 38-91 years]). The authors reviewed available clinical notes and imaging reports. Six patients had posterior operative fixation, and 5 were stabilized nonoperatively. By the time of either discharge or final follow-up, 3 of the patients treated operatively deteriorated neurologically (2 of them preoperatively) and 3 remained stable. Of the patients treated nonoperatively, 3 remained neurologically intact, 1 deteriorated, and 1 recovered completely. The most common complications in all patients were pneumonia and urinary tract infection. Operative and nonoperative management produced acceptable outcomes in most patients. The authors recommend individualized treatment, accounting for patient preferences and comorbidities.