Fractures in ankylosed spines: Current concepts

The incidence of spinal fractures in ankylosing spondylitis (AS) continues to increase despite the improvements in medical treatment. Depleted flexibility and altered biomechanics along with secondary osteoporosis make them more prone to unstable spinal injuries with minor or even unknown trauma. Difficulties in radiological assessment due to associated deformity can often mask the diagnosis. Advanced imaging techniques and screening of the entire spine are required in suspected cases. Surgical treatment is generally indicated because of the inherent instability of these fractures and frequent neurologic deficits. The choice of approach and fixation remains controversial, especially in cervical and cervicothoracic injuries. Whatever be the mode of treatment, the postinjury complication rates remain higher with significant mortality risk in those having associated comorbidities and neurological injury. However, avoidance of injury by adequate preventive measures, a high index of suspicion and appropriate precautions in the perioperative period can result in improved outcomes in these patients. A systematic computerized literature search was performed using Cochrane Database of Systematic Reviews, EMBASE, and PubMed. The publications made over the past 10 years were analyzed. The searches were performed using Medical Subject Headings and the subheadings used were “AS,” “diffuse idiopathic skeletal hyperostosis,” “epidemiology,” “surgery,” “etiology,” “management,” “surgery,” and “therapy.”