Posterior instrumentation and fusion for treating ankylosing spondylitis combined with lower cervical fractures

Objective To investigate outcomes of posterior instrumentation and fusion in treating ankylosing spondylitis (AS) combined with lower cervical fractures. Methods A retrospective case series study was made on 53 AS patients combined with cervical fractures or cervical thoracic fractures treated by posterior instrumentation and fusion from January 2006 to January 2013. There were 51 male and 2 female patients. The mean age of patients was 55 years old (range, 34-69 years old). All the patients showed significant kyphosis on the thoracolumbar and cervicothoracic junction. A total of 20 patients had neurological dysfunction at different extents. According to the American spinal injury association (ASIA) classification, neurological status was scored as Grade A in 4 cases, Grade B in 5, Grade C in 4 and Grade D in 7. The operation time, total bleeding and decompression status were recorded during the surgery. Reduction, decompression condition and complications were evaluated. The neurological status and bone fusion were recorded at the follow-up. Results All surgeries were well accomplished. Mean surgical time was 3. 7 h (range, 2.9-5.3 h). Mean total bleeding was 690 ml (range, 470-1 600 ml). Two patients died within 1 year follow-up because of internal diseases (1 case caused by respiratory system disease in 13 months postoperatively and 1 case caused by acute myocardial infarction in 15 months postoperatively). The mean follow-up time of other patients was 25 months (range, 18-48 months). The CT scan manifested all patients achieved satisfactory fusion, and the mean time span of the fusion was 3.5 months (range, 3-6 months) postoperatively. Among the 20 patients with various levels of neurological deficits before operation, the postoperative ASIA score was Grade A in 4 cases, Grade C in 2, Grade D in 4, and Grade E in 10. No instrumentation failure occurred during follow-up. Conclusion The posterior instrumentation and fusion for treating AS combined with cervical fractures can obtain satisfactory neurological results, spinal stabilization and clinical results, and hence an effective clinical problem-solving algorithm for such kind of patients. Key words: Spondylitis, ankylosing; Cervical vertebrae; Fractures fixation, internal; Posterior instrumentation