Vertebral Fractures in Patients with Ankylosing Spondylitis: A Retrospective Analysis of 66 Patients

Purpose: Retrospective analysis of vertebral fractures in patients with ankylosing spondylitis (AS) for the evaluation of associations with mortality, concurrent neurological deficits, and other complications. Materials and Methods: Image analysis (conventional radiographs, CT, MRI) was applied to all patients with AS admitted between 1997 and 2007 due to vertebral fractures to determine fracture location and classification. Patient characteristics, trauma mechanism, neurological symptoms, and other complications were documented. Results: 66 patients (54 male, age 64 +/- 11 years) were enrolled in the study. 74% of patients suffered from minor trauma. 51% and 56% had cervicothoracic and thoracolumbar fractures, respectively, while 8% had multi-level fractures. 63% of patients suffered combined vertebrodiscal fractures. 70% revealed neurological symptoms, significantly correlating with spinal stenosis (p=0.024; Odds ratio 4.265) and hyperlordosis (p=0.014; OR 4.806). 68% developed complications with non-combined fractures (p=.042; OR 4.954) and paravertebral hematomas (p=.009; OR 16.969) representing independent risk factors. The female gender (p=0.005; OR 15.617) and conservative therapy (p=0.040; OR .094) exerted significant influence on the mortality rate. Conclusion: Vertebral fractures frequently occur in patients with AS after minor trauma and often lead to neurological symptoms, which in turn are associated with spinal stenosis and hyperlordosis. Paravertebral hematomas and non-combined fractures are accompanied by higher incidences of other complications. The female gender entails a higher mortality rate.