Independent Factors Affect Prognosis of Cervical Spine Fractures in Patients With Ankylosing Spondylitis

x-ray of cervical spine, neck
Researchers assessed the prognostic factors of postoperative outcomes for cervical spine fractures in patients with ankylosing spondylitis.

Basic treatment for ankylosing spondylitis (AS), spinal cord injury, and surgical methods are potential predictors of surgical outcomes in patients with AS and cervical spinal fracture, according to study results published in Spine.

Patients with AS are at an increased risk for fragility fractures of the spine, and 50% to 55% of vertebral fractures are located in the lower cervical spine. Limited data exist on the impact of the surgical method, timing of surgery, treatment of AS, and different doses of steroid therapy on the prognosis.

The objective of the current study was to identify prognostic factors of surgical outcomes after cervical spinal fracture in patients with AS.

Researchers used the Japanese Orthopedic Association (JOA) scores to determine spinal cord function before and after surgical intervention in patients with AS and traumatic cervical fractures. They used the visual analog scale was to assess the neck pain severity.

The retrospective study included 41 patients, of whom complete data were available for 23 (21 men; mean age, 39.6 years). Cervical fractures most often occurred in the C7-T1 (26.1%), with spinal cord injury documented in 12 patients (52.2%).

Timing of surgery was important; the JOA score was higher in those who underwent surgery within 72 hours of injury compared with those who had the intervention at a later stage (P =.01). The mean JOA score was significantly lower among patients with spinal cord injury (3.91 vs 6.83, respectively; P =.03) and among those with a degree of cervical fracture displacement less than 50% before the surgery (15.36 vs 6.83, respectively; P =.03). Researchers noted that the JOA score was lower among patients with cervical fractures in C7-T1 compared with those with a fracture in C4-C6, but the difference was not statistically significant.

Following the surgical intervention, JOA scores were higher after a combined anterior and posterior approach compared with a posterior-single approach (14.82 vs 9.00, P =.000) among patients with degree of cervical fracture displacement less than 50% compared with severe cervical displacement (15.36 vs 10.11, P =.000) and when surgery was completed early after the injury (16.40 vs 10.92, P =.000).

Postoperative increase in JOA score was statistically significant in patients after anterior-posterior segmental fixation surgery compared with posterior-only fixation (JOA scale change, 8.88 vs 5.00, P =.01) among those with a history of AS treatment (9.36 vs 5.56, P =0) and among those without spinal cord injury (9.82 vs 6.08, P =0).

The study had several limitations, including the small sample size, insufficient evaluation indicators, and limited available data on AS treatment methods.

“Basic AS treatment, [spinal cord injury], and surgical methods are independent factors that affect the prognosis of cervical spine fractures patients with AS,” the researchers concluded.


Gao Q, Zhang Z, Shao T, et al. Predictor of surgical outcomes in ankylosing spondylitis cervical spinal fracture: an at least 2 years follow-up retrospective study. Spine. Published online January 1, 2021. doi:10.1097/BRS.0000000000003754