Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation

Study Design. Introduction of a posterior approach for internal internal fi xation of fractures of the ankylosed cervical spine. Objectives. To evaluate the clinical outcome of patients with ankylosing sp ondylitis and cervical spinal fractures treated with posterior instrumentat ion and a collar orthosis. Summary of Background Data. Cervical spinal fractures in patients with anky losing spondylitis almost always extend completely across the vertebral seg ment to include both anterior and posterior elements. Treatment with immobi lization alone is often inadequate. Generalized spinal rigidity and exagger ated thoracic kyphosis may hinder anterior exposure. Posterior approaches h ave been described but generally require postoperative halo immobilization. In the authors' technique for patients hose spinal alignment is relatively well preserved, a posterior exposure is used that achieves three-point int ernal fixation along multiple segments. The complications associated with h alo immobilization are avoided. Methods. Seven patients with ankylosing spondylitis and fractures of the Ce rvical spine were stabilized with posterior instrumentation. Patients were immobilized after surgery with either a cervical collar or a sternal occipi tal mandibular immobilizing brace and observed for neurologic outcome, radi ographic evidence of bony fusion, and complications. Results. No patient experienced neurologic deterioration with surgery. Two patients died at acute rehabilitative facilities after discharge. Radiograp hic evidence of fusion was observed in the five patients available for foll ow-up. Conclusions. Patients with ankylosing spondylitis and cervical spinal fract ures can be adequately treated with lateral mass plating ana interspinous w iring of autologous rib graft. Adequate postoperative immobilization can be attained with a:cervical collar and does not require a halo vest.