Treating Cervical Spine Fractures in Patients With Ankylosing Spondylitis

Because various surgical approaches for cervical spine fracture in patients with ankylosing spondylitis (AS) offer good results, new findings published in World Neurosurgery recommend individualized decision-making.

“AS often results in progressive spinal stiffness, making patients prone to spinal fractures. Cervical spine fractures in AS mostly occur in the lower segment and cause progressive neurological deficits,” explained a team of researchers from the orthopedic surgery department at First Affiliated Hospital of Zhengzhou University in China. “However, the optimal approach to treating this patient population is still controversial, and it is unclear what factors have an impact on prognosis.”

The study included 22 patients with AS treated for cervical fracture at the hospital between 2015 and 2020. Among them, 6 underwent an anterior surgical approach, 11 a posterior surgical approach, and 5 a combined surgical approach.

Although all approaches were associated with good outcomes, analysis showed significantly less operative time and intraoperative blood loss for patients who underwent an anterior approach compared with the other approaches, researchers reported.

Regarding timing, patients who underwent surgery within 48 hours of injury had a lower spinal cord function score than patients who underwent surgery later. The study also showed that basic AS treatment before injury significantly improved spinal cord function scores postoperatively.

“All approaches can provide good clinical results, and thus, the surgical approach should be individualized,” concluded researchers. “It remains unclear whether the operation should be performed as soon as possible. Basic AS treatment is an independent factor that affects the prognosis of cervical spine fracture patients with AS.”

Reference:
Tang Z, Chen T, Tan J, Zhang H. Surgical outcomes and prognostic factors for cervical spine fractures in patients with ankylosing spondylitis. World Neurosurg. Published online July 6, 2022. doi:10.1016/j.wneu.2022.06.151