Fracture luxation of the cervical spine in patients with ankylosing spondylitis: Six cases

Background and purpose. - Treatment of cervical spine fracture in patients with ankylosing spondylitis is difficult. Bionrechanical changes related to ossified ankylosing spondylitis spine make cervical spine fractures highly unstable. They cover the entire width of the spine inducing multidirectional instability and the risk of neurological injuries. Treatment is more difficult that in the nonossified spine. Different treatments have been proposed including anterior stabilization, posterior stabilization, or both. Methods. - We reviewed retrospectively six cases of cervical fracture dislocation in patients with ankylosing spondylitis. Results. - There were five cases of C6C7 fracture dislocation and one case of C4C5 fracture dislocation. Four patients had neurological impairment at diagnosis. All patients underwent surgery. Two had anterior stabilization: one patient died and the other achieved bone healing. Four patients had anterior and posterior stabilization combined with a cervical brace for three months, for two and a halo cast for two, others because of persistent instability, with neurological injury in one. A neurological improvement was obtained in four patients. One patient was lost to follow-up. Conclusion. - Surgical management of selected patients wit h ankylosing spondylitis and cervical spine fractures is challenging. Combined anterior and posterior stabilization should be considered for these fractures. A cervical brace must be associated with surgical treatment. With appropriate management, outcome can be favorable. (c) 2008 Elsevier Masson SAS. Tons droits reserves.