Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

Cervical spine fractures in patients with ankylosing spondylitis are serious and potentially lethal injuries with high complication rates. Treatment obstacles include long lever arms that generate large forces on any fixation device, osteoporosis, and, usually, kyphotic deformity. The Olerud Cervical Fixation System (OC), with cervical pedicle screws and rods, offers an opportunity to create a biomechanically stable posterior fixation in these complicated cases. The present study is a retrospective chart review and a radiological follow-up of patients with this diagnosis, treated at our department between 1995 and 2000. Nineteen patients (two women) with a mean age of 60 years (32–78 years) were included. The fracture levels were predominantly C5–C6 (five patients) and C6–C7 (five patients). All patients were treated with a long posterior fixation with the OC, and in four patients this was combined with an anterior plate fixation. One patient with severe lordosis also received a short posterior plate fixation. The patients’ notes and plain radiographs have been reviewed. Five patients died during the post-operative follow-up period; the others had a mean follow-up time of 24 months (10–55 months). Eleven patients had no neurological deficits preoperatively. One of them developed moderate weakness in his right arm, postoperatively, due to a misplaced pedicle screw in the right pedicle of C5. However, after extraction of the screw he almost totally recovered in 6 months. Eight patients had neurological deficits. Two were paraplegic; two had motor weakness combined with sensory deficiency, and four had a sensory deficiency. Two of the patients with neurological deficits improved postoperatively, but the others were unchanged. Peroperative problems were recorded in five patients; one C6 pedicle was perforated, and two patients had pedicles on one or more levels that the surgeon was not able to probe. In one of the latter patients, transfacet screws were chosen, instead, for one of the levels. Extensive peroperative bleeding was encountered in two patients. One deep-wound infection was noted, postoperatively, and required surgical drainage, but no patients have been re-operated due to loosening of the instrument or to healing problems. In conclusion, the results of the present study indicate that the OC—and possibly other similar long-fixation systems that allow using both pedicle screws and lateral mass screws rigidly connected to a rod—is suited for treating subaxial cervical spine fractures in patients with ankylosing spondylitis, allowing high healing rates.