Surgical Approach to Cervical Fractures in Ankylosing Spondylitis Patients: Rationale and Surgical Strategy

-BACKGROUND: Current literature lacks objective criteria to determine surgical management in patients with ankylosing spondylitis who sustain cervical fractures. The purpose of our study was to analyze the determinants for stratifying surgical approach, evaluate the outcome in pa-tients, and postulate a management strategy.-METHODS: This was a retrospective study of patients with ankylosing spondylitis who underwent surgery for cervical spine injury with a minimum follow-up of 2 years. Neurological recovery, fracture pattern including trans-lation and angulation, surgical duration, blood loss, and postoperative complications were recorded, and a comparative analysis of these factors with anterior, pos-terior, and combined surgical approaches was performed.-RESULTS: The study included 43 men with a mean age of 57 years; 49% underwent anterior-only stabilization, 16% u nderwent posterior-only stabilization, and 35% underwent combined anteroposterior stabilization. Mean operative time was significantly lower in anterior-only (81.4 minutes; P < 0.05) and posterior-only (124 minutes; P < 0.05) ap-proaches compared with combined approach (266.6 mi-n utes). Mean blood loss was significantly lower in anterior-only (87.5 mL, P < 0.05) approach compared with posterior-only (714.7 mL) and combined (912.7 mL) ap-proaches. Mean translation was 1.8 mm, 1.7 mm, and 3.7 mm in anterior, posterior, and combined approaches (P < 0.05), respectively.-CONCLUSIONS: Our study provides insights into man-agement of cervical spine fractures in ankylosing spondylitis patients. A fracture displacement 2 pound mm may be successfully managed by an anterior approach, while the posterior approach may be beneficial in similar frac -tures warranting instrumentation extending to the thoracic spine. All other fractures warrant a combined surgical approach.