Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach?

Introduction: Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures. Sources of data: A systematic review was undertaken using the keywords 'ankylosing spondylitis', 'spine fractures', 'cervical fractures', 'surgery' and 'postoperative outcomes' on Medline, Pubmed, Google Scholar, Ovid and Embase, and the quality of the studies included was evaluated according to the Coleman Methodology Score. Areas of agreement: Surgery ameliorates neurological function in patients with unstable AS-related cervical fractures. The combined anterior/posterior and the posterior approaches are more effective than the anterior approach. Areas of controversy: The optimal approach, anterior, posterior or combined anterior/posterior, for the management of AS related cervical fractures has not been defined. Growing points: Open reduction and internal fixation allows avoiding worsening and enhances neurological function in AS patients with cervical fractures. Areas timely for developing research: Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions.