Fracture of the lower cervical spine in patients with ankylosing spondylitis: Retrospective study of 19 cases - 02/08/12

Doi : 10.1016/j.otsr.2012.03.011

P. Kouyoumdjian ^a,^⁎ , P. Guerin ^b, C. Schaelderle ^b, G. Asencio ^a, O. Gille ^b
^a Department of Orthopaedic Surgery and Traumatology, Carémeau Teaching Hospital center, place du Pr-Debré, 30029 Nîmes cedex 9, France
^b Spine diseases Unit, René Pellegrin Hospital, Bordeaux Teaching Hospital center, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France

Corresponding author. Tel.: +33 06 03 99 80/04 66 68 31 56.

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Summary

Introduction

Controversy exists surrounding optimal treatment of cervical spine fractures secondary to ankylosing spondylitis (AS).

Hypothesis

The anterior approach is an effective surgical technique for these fractures and can be used to correct the AS-induced cervical-thoracic kyphosis.

Materials and methods

This continuous, retrospective series between 1990 and 2010 included 19 patients aged 33 to 84 years who presented with a lower cervical spine fracture in the context of AS. The average follow-up was 45 months. Sixteen of these patients were surgically treated using an anterior approach and anterior fixation. In five patients without any neurological deficit, their cervical-thoracic kyphosis was corrected during the same surgery. Regional kyphosis was measured before the surgery, immediately after the surgery and at the last follow-up.

Results

Five deaths occurred; these were all patients with post-traumatic complete quadriplegia. Most the incomplete neurological problems improved (66%). In no cases did the neurological condition worsen. Among the 16 patients operated with the anterior approach, two patients also required an additional procedure with a posterior approach because of a persistent neurological deficit. The fractures in the operated patients who survived (14 patients) had healed within an average 4-month delay (range 3–7 months), without worsening of the kyphosis at final follow-up. In the five cases where the kyphosis was corrected, the correction averaged 26° (range 18–36°); there were no neurological complications.

Discussion

Based on these results, we suggest using the anterior approach to perform internal fixation as a treatment for cervical fractures secondary to AS and to correct the cervical-thoracic kyphosis in patients without neurological deficits.