Anterior and posterior fixation of spinal fracture in patients with ankylos- ing spondylitis

Abstract

Objective. To evaluate the outcomes and methods of surgical treatment of patients with fractures of the cervical and thoracolumbar spine in ankylosing spondylitis. Material and Methods. The study included 19 patients with ankylosing spondylitis, spinal fractures were diagnosed in seven of them. The average age of patients with fractures was 39 years (range: 32–58 years). Injuries to the cervical spine were observed in three patients, and to the lumbar – in four. Among patients with lumbar spine injuries, a clinical picture of profound inferior paresis was observed in one patient with previous kyphosis. Paraplegia was diagnosed in two patients with fractures at the C5–C6 level, and radicular pain – in one patient with injury at the C5–C6 level. The remaining patients had no neurological disorders. Patients were operated on in the period from three days to two weeks after the injury. CT study to confirm the diagnosis was performed in all patients. Injuries to the cervical spine were treated by anterior fixation, to the thoracolumbar spine – by transpedicular fixation. Results. The results were evaluated according to X-ray and CT findings, as well as to a degree of neurological regression. Complications, instrumentation removal and increase in spinal deformity were not observed. In one patient with the cervical spine fracture, the pain caused by radicular irritation was eliminated. A regression of neurological complications from Frankel B to Frankel D was observed in one patient with the Th12–L1 fracture. Conclusion. Surgical stabilization of the spine is the method of choice for the treatment of spinal fractures in ankylosing spondylitis. Grad- uated correction of kyphotic deformity in fractures may be one of the elements of surgical treatment.

Keywords

• ankylosing spondylitis
• fractures
• fixation
• correction