European Spine Journal

, Volume 14, Issue 4, pp 401–408 | Cite as

Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

  • Michael CornefjordEmail author
  • M. Alemany
  • C. Olerud
Original Article


Cervical spine fractures in patients with ankylosing spondylitis are serious and potentially lethal injuries with high complication rates. Treatment obstacles include long lever arms that generate large forces on any fixation device, osteoporosis, and, usually, kyphotic deformity. The Olerud Cervical Fixation System (OC), with cervical pedicle screws and rods, offers an opportunity to create a biomechanically stable posterior fixation in these complicated cases. The present study is a retrospective chart review and a radiological follow-up of patients with this diagnosis, treated at our department between 1995 and 2000. Nineteen patients (two women) with a mean age of 60 years (32–78 years) were included. The fracture levels were predominantly C5–C6 (five patients) and C6–C7 (five patients). All patients were treated with a long posterior fixation with the OC, and in four patients this was combined with an anterior plate fixation. One patient with severe lordosis also received a short posterior plate fixation. The patients’ notes and plain radiographs have been reviewed. Five patients died during the post-operative follow-up period; the others had a mean follow-up time of 24 months (10–55 months). Eleven patients had no neurological deficits preoperatively. One of them developed moderate weakness in his right arm, postoperatively, due to a misplaced pedicle screw in the right pedicle of C5. However, after extraction of the screw he almost totally recovered in 6 months. Eight patients had neurological deficits. Two were paraplegic; two had motor weakness combined with sensory deficiency, and four had a sensory deficiency. Two of the patients with neurological deficits improved postoperatively, but the others were unchanged. Peroperative problems were recorded in five patients; one C6 pedicle was perforated, and two patients had pedicles on one or more levels that the surgeon was not able to probe. In one of the latter patients, transfacet screws were chosen, instead, for one of the levels. Extensive peroperative bleeding was encountered in two patients. One deep-wound infection was noted, postoperatively, and required surgical drainage, but no patients have been re-operated due to loosening of the instrument or to healing problems. In conclusion, the results of the present study indicate that the OC—and possibly other similar long-fixation systems that allow using both pedicle screws and lateral mass screws rigidly connected to a rod—is suited for treating subaxial cervical spine fractures in patients with ankylosing spondylitis, allowing high healing rates.


Spinal fusion Spinal fracture Fracture fixation Cervical vertebrae Ankylosing spondylitis 


  1. 1.
    Abumi K, Shono Y, Taneichi H, Ito M, Kaneda K (1999) Correction of cervical kyphosis using pedicle screw fixation systems. Spine 24(22):2389–2396CrossRefPubMedGoogle Scholar
  2. 2.
    Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complication of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25(8):962–969CrossRefPubMedGoogle Scholar
  3. 3.
    Amamilo SC (1989) Fractures of the cervical spine in patients with ankylosing spondylitis. Orthop Rev 18(3):339–344PubMedGoogle Scholar
  4. 4.
    Bohlman HH (1979) Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am 61:1119–1142PubMedGoogle Scholar
  5. 5.
    Broom MJ, Raycroft JF (1988) Complications of fractures of the cervical spine in ankylosing spondylitis. Spine 13(7):763–766PubMedGoogle Scholar
  6. 6.
    Coe JD, Warden KE, Sutterlin CE 3rd, McAfee PC (1989) Biomechanical evaluation of cervical spinal stabilization in a human cadaveric model. Spine 14(10):1122–1131PubMedGoogle Scholar
  7. 7.
    Cooper PR, Maravilla KR, Sklar FH, Moody SF, Clark WK (1979) Halo immobilization of cervical spine fractures: Indications and results. J Neurosurg 51:603–610Google Scholar
  8. 8.
    Cooper PR, Cohen A, Rosiello A, Koslow M (1988) Posterior stabilization of cervical spine fractures and subluxations using plates and screws. Neurosurgery 23(3):300–306PubMedGoogle Scholar
  9. 9.
    Cooper C, Carbone L, Michet CJ, Atkinson EJ, O’Fallon WM, Melton LJ (1994) Fracture risk in patients with ankylosing spondylitis: A population-based study. J Rheumatol 21:1877–1882PubMedGoogle Scholar
  10. 10.
    Detwiler KN, Loftus CM, Godersky JC, Menezes AH (1990) Management of cervical spine injuries in patients with ankylosing spondylitis. J Neurosurg 72:210–215PubMedGoogle Scholar
  11. 11.
    Do Koh Y, Lim TH, Won You J, Eck J, An HS (2001) A biomechanical comparison of modern anterior and posterior plate fixation of the cervial spine. Spine 26(1):15–21PubMedGoogle Scholar
  12. 12.
    Exner G, Botel U, Kluger P, Richter M, Eggers C, Ruidisch M (1998) Treatment of fracture and complication of cervical spine in ankylosing spondylitis. Spinal Cord 36(6):377–379CrossRefPubMedGoogle Scholar
  13. 13.
    Farhat SM, Schneider RC, Gray JM (1973) Traumatic spinal extradural hematoma associated with cervical fractures in rheumatoid spondylitis. J Trauma 13:591–599PubMedGoogle Scholar
  14. 14.
    Farmer J, Vaccaro A, Albert TJ, Malone S, Balderston RA, Cotler JM (1988) Neurologic deterioration after cervical spinal cord injury. J Spinal Disord 11(3):192–196Google Scholar
  15. 15.
    Foo D, Rossier AB (1982) Post-traumatic spinal epidural hematoma. Neurosurgery 11:25–32PubMedGoogle Scholar
  16. 16.
    Foo D, Sarkarati M, Marcelino V (1985) Cervical spinal cord injury complicating ankylosing spondylitis. Paraplegia 23:358–363PubMedGoogle Scholar
  17. 17.
    Fox MW, Onofrio BM, Kilgore JE (1993) Neurological complications of ankylosing spondylitis. J Neurosurg 78(6):871–878PubMedGoogle Scholar
  18. 18.
    Gallie WE (1939) Fractures and dislocations of the cervical spine. Am J Surg 46:495–499CrossRefGoogle Scholar
  19. 19.
    Graham B, Van Peteghem (1989) Fractures of the spine in ankylosing spondylitis: Diagnosis, treatment and complications. Spine 14:803–807PubMedGoogle Scholar
  20. 20.
    Harding JR, Mc Call IW, Park WM, Jones BF (1985) Fracture of the cervical spine in ankylosing spondylitis. Br J Radiol 58:3–7PubMedGoogle Scholar
  21. 21.
    Harris BM, Hilibrand AS, Nien YH, Nachwalter R, Vaccaro A, Albert TJ and Siegler S (2001) A Comparison of screw types for unicortical fixation in the lateral mass of the cervical spine. Spine 26(22):2427–2431CrossRefPubMedGoogle Scholar
  22. 22.
    Hunter T, Dubo H (1978) Spinal fractures complicating ankylosing spondylitis. Ann Intern Med 88:546–549PubMedGoogle Scholar
  23. 23.
    Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine 22(9):9777–9982CrossRefGoogle Scholar
  24. 24.
    Karaikovic EE, Yingsakmongkol W, Gaines RW Jr (2001) Accuracy of cervical pedicle screw placement using the funnel technique. Spine 26(22):2456–2462CrossRefPubMedGoogle Scholar
  25. 25.
    Kewalramani LS, Taylor RG, Albrand OW (1975) Cervical spine injury in patients with ankylosing spondylitis. J Trauma 15(10):931–934PubMedGoogle Scholar
  26. 26.
    Kiwerski J, Wieclawek H, Garwacka I (1985) Fractures of the cervical spine in ankylosing spondylitis. Int Orthop 8(4):243–246PubMedGoogle Scholar
  27. 27.
    Klekamp JW, Ugbo JL, Heller JG, Hutton WC (2000) Cervical transfacet versus lateral mass screws. A biomechanical comparison. J Spinal Disord 13(6):515–518CrossRefPubMedGoogle Scholar
  28. 28.
    Ludwig SC, Kowalski JM, Edwards CC 2nd, Heller JG (2000) Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine 25(20):2675–2681CrossRefPubMedGoogle Scholar
  29. 29.
    Muffoletto AJ, Yang J, Vadhva M, Hadjipavlou AG (2003) Cervical stability with lateral mass plating: unicortical versus bicortical screw purchase. Spine 28(8):778–791CrossRefPubMedGoogle Scholar
  30. 30.
    Murray GC, Persellin RH (1981) Cervical fracture complicating ankylosing spondylitis: a report of eight cases and review of the literature. Am J Med 70(5):1033–1041PubMedGoogle Scholar
  31. 31.
    Ohry A, Frankel HL (1984) Rehabilitation after spinal cord injuries complicated by previous lesions. Paraplegia 22:291–296PubMedGoogle Scholar
  32. 32.
    Olerud C, Frost A, Bring J (1996) Spinal fractures in patients with ankylosing spondylitis. Eur Spine J 5:51–55PubMedGoogle Scholar
  33. 33.
    Olerud C, Lind B, Sahlstedt B (1999) The Olerud cervical fixation system; a study of safety and efficacy. Ups J Med Sci 104:131–143PubMedGoogle Scholar
  34. 34.
    Papagelopoulos PJ, Sapkas GS, Kateros KT, Papadakis SA, Vlamis JA, Falagas ME (2001) Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: case report and review of the literature. Spine 26(19):E463–467CrossRefPubMedGoogle Scholar
  35. 35.
    Rowed DW (1992) Management of cervical spinal cord injury in ankylosing spondylitis: the intervertebral disc as a cause of cord compression. J Neurosurg 77(2):241–246PubMedGoogle Scholar
  36. 36.
    Schmidt R, Wilke HJ, Claes L, Puhl W, Richter M (2003) Pedicle screws enhance primary stability in multilevel corpectomies: Biomechanical in vitro comparison of different implants including constrained and nonconstrained posterior instrumentations. Spine 28(16):1821–1828CrossRefPubMedGoogle Scholar
  37. 37.
    Seybold EA, Baker JA, Criscitello A, Ordway NR, Park CK, Conno PJ (1999) Characteristics of unicortical and bicortical lateral mass screws in the cervical spine. Spine 24(22):2397–2403CrossRefPubMedGoogle Scholar
  38. 38.
    Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS (2003) Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine. Spine 28(20):2352–2358CrossRefPubMedGoogle Scholar
  39. 39.
    Stiasny H (1933) Fraktur der Halswirbelsaulen bei Spondylarthritis ankylopoetica. Zentralbibl Chir 60:998–1005Google Scholar
  40. 40.
    Surin VV (1980) Fractures of the cervical spine in patients with ankylosing spondylitis. Acta Orthop Scand 51:79–84PubMedGoogle Scholar
  41. 41.
    Taggard DA, Traynelis VC (2000) Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation. Spine 25(16):2035–2039CrossRefPubMedGoogle Scholar
  42. 42.
    Weinstein PR, Karpman PR, Gall EP (1982) Spinal cord injury, spinal fracture, and spinal stenosis in ankylosing spondylitis. J Neurosurg 57:609–616PubMedGoogle Scholar
  43. 43.
    Young JS, Cheshire DJE, Pierce JA, Vivian JM (1977) Cervical ankylosis with acute spinal cord injury. Paraplegia 15:133–146PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Spine Surgery Unit, Department of OrthopaedicsUppsala University HospitalUppsalaSweden
  2. 2.Department of RadiologyUppsala University HospitalUppsalaSweden
  3. 3.Department of OrthopaedicsUppsala University HospitalUppsalaSweden

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