Minimally Invasive Surgery for Traumatic Fractures in Ankylosing Spinal Diseases

Study Design Retrospective case series. Objective Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are two related diseases that significantly increase the risk of unstable spinal fractures from seemingly trivial trauma. Given the older age and higher surgical risk profile of most of these patients, minimally invasive (MIS) approaches to the treatment of such fractures may reduce operative risk and physiologic stress. Methods Eleven consecutive patients with hyperextension thoracolumbar injuries and a diagnosis of AS or DISH admitted to a single level I trauma center between June 2009 and June 2014 were retrospectively reviewed. All patients were treated with MIS stabilization. In addition, the patients were administered the Oswestry Disability Index and EuroQol-5D surveys to evaluate patient-reported outcomes regarding disability and health-related quality of life, respectively. Results Of the 11 patients, 10 were alive at the time of review. The mean follow-up time was 28 months. The average age was 77 years old with a mean body mass index of 34. All patients had severe systemic disease, American Society of Anesthesiologists grade III, with multiple medical comorbidities. Seven segments on average were included in the operative construct. There were no instrumentation failures or nonunions requiring revision surgery. The average postoperative Oswestry disability index was 21.5% (range: 0 to 34%), corresponding to low to moderate disability, and the average EuroQol-5D utility score was 0.77 (range: 0.60 to 1), a similar average postoperative utility value to those published in the literature on elective surgery for degenerative lumbar conditions. Conclusions MIS stabilization, when used on patients with good preoperative neurologic status, can successfully manage spinal fractures in patients with AS and DISH and preserve a favorable postoperative quality of life with limited disability.