A Comprehensive Analysis of Surgical Outcomes for Spinal Fractures in Patients With Ankylosing Spondylitis: A 13-Year Prospective Study

Introduction: Ankylosing spondylitis (AS), a chronic inflammatory spondyloarthropathy affecting the spine, progressively leads to increased spinal stiffness. This condition increases the risk of spine fractures in patients, even from trivial injuries. The process of slow bone formation within the ligaments of the spine and the fusion of the spinal diarthrosis contribute to the most prominent symptom of progressive stiffness of joints, predominantly affecting the spine and sacroiliac joints. In advanced AS, the ossification of the paraspinal tissues and inflammatory osteitis result in a spine that is brittle and fragile, making it susceptible to fractures.

Objective: This study aimed to observe and analyze the postoperative surgical outcomes after spine fracture fixations in patients with AS, focusing on the intricacies that exist in diagnosis and surgical treatment.

Methods: A prospective interventional study was conducted in a tertiary care center during the period from 2010 to 2023. This study evaluated 25 cases of spinal fractures diagnosed with AS.

Results: The mean patient age was 58.61 ± 18.54 years, with the majority being male (72%; n = 18) over female (28%; n = 7). The predominant cause of injury was falling from a height (56%, n = 14), and the most frequent fracture location was the C7-T1 (n = 10). Fracture distribution included cervical (32%, n = 8), lumbar (28%, n = 7), thoracic (24%, n = 6), and thoracolumbar (16%, n = 4). Sixteen percent (n = 4) of the patients had no fracture on X-rays but eventually were diagnosed with a fracture on an MRI. Following surgery, there was a notable improvement in neck disability index (NDI) and visual analog scale (VAS) scores (p < 0.05). Neurological status improvement was observed, with 24% (n = 6) of patients improving to Frankel D and 68% (n = 17) to Frankel E. The postoperative complication noted was wound infection in 8% (n = 2) of the cases.

Conclusion: This study emphasizes the effectiveness of anterior surgical interventions for treating spine fractures in AS patients, as shown by significant improvements in both quality of life and neurological status. Despite the complexities of treating spinal fractures in this population, marked by a high incidence of cervical and lumbar injuries, our results demonstrate positive outcomes. The occurrence of postoperative complications such as sepsis and instrumentation failure necessitates careful surgical planning and attentive postoperative care. This study offers valuable insights for enhancing treatment strategies and patient management in cases of spine trauma involving AS.