Unstable Cervical Fractures with Long Standing Ankylosing Spondylitis: Report of Six Cases

Purpose: Irrespective of the degree of trauma, patients with ankylosing spondylitis may suffer from cer- vical spinal fractures which are associated with high rates of morbidity and mortality. However, there has been no common consensus on how to manage such patients. It seems that the management depends large- ly on the physician's decision, some recommend nonsurgical treatment while others recommend surgical intervention. Our aim is to contribute to the literature regarding the decision-making in ankylosing spon- dylitis patients associated with cervical fractures by presenting six cases. Methods: The clinical features and management of six patients were presented and discussed under the light of relevant literature. All six patients had history of ankylosing spondylitis for more than 15 years. Fractures were caused by minor trauma in fi ve and major trauma in one patient. Three patients were man- aged conservatively, but one of them then underwent decompression surgery because of an unsuccessfull reduction, while the other three had surgical stabilizations. Results: Two patients died: one after surgery and one during nonsurgical management. Considering the cervical fractures of patients with ankylosing spondylitis, the decision-making must be carried out seper- ately for each patient according to his or her clinical condition. Conclusion: We advise surgery in patients with neurological defi cit while nonsurgical management should be the fi rst choice of treatment in cases with no neurological defi cits. Furthermore, if nonsurgical treatment fails, irrespective of the neurological status, surgical intervention should also be considered.