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Cervical spine fractures in ankylosing spondylitis patients: an analysis of the presentation and clinical results of 110 surgically managed patients in two spine centers

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Abstract

Purpose

In this work, a two-center study was performed to study the clinical presentation of cervical spine fractures in ankylosing spondylitis (AS) patients and assess the surgical management of these fractures.

Methods

A retrospective analysis of prospectively collected data in two level-1 spine surgery centers was performed. Both spine centers have a standard database for all admitted patients. Inclusion criteria were surgically treated AS with cervical spine fracture diagnosis (from C1 to Th3) and postoperative follow-up minimum of 12 months.

Results

One hundred ten patients (105 male/5 female) were included. The mean age was 62 ± 10 years. The mean time between trauma and surgery was 49 ± 42 days. There was a history of mild trauma in 72 patients (65.4%). The clinical presentation was a pain in all patients. Twenty-seven (24.6%) had a neurological deficit at admission. The most common fracture level was C6/7 in 63 patients (57.23%). The VAS was 7 ± 1, and NDI was 34 ± 8 in the preoperative assessment. The mean preoperative kyphosis angle was 48 ± 26° between C2 and C7.

Positioning and preparing of the patients on the operation table took a mean of 57 ± 28 min. The surgical approach was dorsal in 59 patients (53.6%), combined in 45 patients (40.9%), and ventral in 6 patients (6,5%). The mean number of the fixed levels was 6 ± 2 levels.

Intraoperative complications occurred in 9 patients (8.2%). Postoperative Cobb angle improved to a mean of 17 ± 9 degrees. Neurological improvement occurred in 20/27 patients. In 12 patients, the recovery was complete. The mean postoperative follow-up was 46 ± 18 months. VAS improved to 3 ± 1, and NDI improved to 14 ± 6 at the last postoperative visit. The improvement was clinically significant (p = 0.01 and 0.00, respectively).

Conclusion

High suspicion of cervical spine fractures is necessary for patients with AS. CT and MRI images are necessary to rule out cervical spine fractures in AS patients, especially to detect occult fractures. Surgical treatment is safe, and the posterior approach with long-segment fusion is the approach of choice in this group of patients.

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Authors and Affiliations

  1. Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany

    Mohamed Alhashash & Mootaz Shousha

  2. Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany

    Christoph‑Eckhard Heyde & Nicolas Heinz von der Höh

  3. Orthopaedic and Traumatology Department, Alexandria University, Alexandria, Egypt

    Mohamed Alhashash & Mootaz Shousha

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  1. Mohamed Alhashash
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  2. Mootaz Shousha
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  3. Christoph‑Eckhard Heyde
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  4. Nicolas Heinz von der Höh
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Correspondence to Mohamed Alhashash.

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Alhashash, M., Shousha, M., Heyde, C. et al. Cervical spine fractures in ankylosing spondylitis patients: an analysis of the presentation and clinical results of 110 surgically managed patients in two spine centers. Eur Spine J 32, 2131–2139 (2023). https://doi.org/10.1007/s00586-023-07692-7

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  • DOI: https://doi.org/10.1007/s00586-023-07692-7

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