Cervical spine fractures in ankylosing spondylitis

Even low-energy trauma can lead to serious fractures of the spine in patients with ankylosing spondylitis (AS). These patients have a greater risk of suffering from neurological impairment and this can also occur after a delay of several days. Newly occurring back pain in AS patients without any recognized trauma should be treated as a fracture unless proven otherwise. This highlights the importance of accurate clinical and radiological examinations, which should be repeated at short intervals, especially if the patient complains of indefinable pain or shows neurological symptoms. Simple X-ray examinations of the spine are usually not sufficient to exclude a fracture, particularly in the junction zones. A computed tomography (CT) scan should be carried out in any case and if in doubt, magnetic resonance imaging (MRI) in fat-suppressed short inversion time inversion recovery (STIR) weighting should also be performed. Surgical treatment of AS injuries is the safest and most effective method of treatment. Immediate stabilization of the fracture site enables early mobilization, which can avoid the risk of complications due to longer immobilization. In addition, in this way the neurological status can be effectively improved. Nevertheless, the surgical treatment of cervical spine fractures in AS is very challenging. The primary surgical procedure of choice is posterior long segment spinal fusion. Due to kyphotic deformities and risk of pulmonary and cardiac comorbidities, primary ventral plating is usually not indicated. If the posterior fusion is long enough, there is usually no need for an additional secondary anterior procedure.