Surgical Outcomes and Prognostic Factors for Cervical Spine Fractures in Patients with Ankylosing Spondylitis

BACKGROUND: Ankylosing spondylitis (AS) often re-sults 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. However, the optimal approach to treating this patient population is still controversial, and it is unclear what factors have an impact on prognosis. Thus, this study aimed to investigate the choice of surgical approach and prognostic factors in AS patients with cer-vical spine fractures.METHODS: A total of 22 AS patients with cervical fracture who were treated in our institution were reviewed from 2015 to 2020. We analyzed demographic data, peri-operative complications, postoperative results, and radio-graphic results. The Japanese Orthopaedic Association (JOA) score was used to assess preoperative and post-operative spinal cord function, and the improvement rate was calculated.RESULTS: Twenty-two patients were enrolled, including 6 patients in the anterior approach group, 11 in the poste-rior approach group, and 5 in the combined approach group. The operative time and intraoperative blood loss in the anterior approach group were significantly less than those in the posterior approach group and combined approach group (P = 0.00). Patients who underwent sur-gery within 48 hours of injury had a lower JOA score than patients who underwent surgery later (P = 0.01). Basic AS treatment before injury significantly improved JOA scores after surgery (P = 0.01).CONCLUSIONS: All approaches can provide good clin-ical results, and thus, the surgical approach should be individualized. It remains unclear whether the operation should be performed as soon as possible. Basic AS treat-ment is an independent factor that affects the prognosis of cervical spine fracture patients with AS.

Automated summary

This study investigated the choice of surgical approach and prognostic factors in AS patients with cervical spine fractures. The results showed that all approaches can provide good clinical results, and thus, the surgical approach should be individualized. The operative time and intraoperative blood loss were significantly less in the anterior approach group compared to the posterior approach group and combined approach group. Patients who underwent surgery within 48 hours of injury had a lower JOA score than patients who underwent surgery later. Basic AS treatment before injury significantly improved JOA scores after surgery.