Management of Cervical Spinal Fractures in Ankylosing Spondylitis
The first reported case of cervical spine injury in a patient with ankylosing spondylitis (AS) appeared in 1933 (1). Subsequently, numerous publications have shown the incidence of traumatic cervical injury in patients with AS to be appreciably higher than the general population without AS (2,3). There are several major reasons for this discrepancy. Patients with AS are more prone to fall because of the compromised balance which accompanies the disease. Additionally, the lack of spinal mobility coupled with the frequent comorbidity of osteoporosis increases the risk of fracture to such an extent that cervical spinal injuries occur regularly following even trivial falls (2,4–11). Frequently all the spinal elements across the anterior-posterior (AP) plane are disrupted, resulting in complete three-column instability. Cervical spinal fractures in the presence of AS are particularly serious, and the mortality ranges from 35% to 50% depending on the series (6,7,12,13). Although reports by several groups have implicated hyperextension as the most frequent mechanism of injury to the cervical spine, forces in any vector can result in fractures. Flexion injuries, in particular, may lead to vertebral body fractures (7,10,13–18).
