Spine fractures in patients with ankylosing spinal disorders.
METHODS
Retrospective review.


OBJECTIVE
To describe the spine fracture characteristics, current treatments, and their results in patients with ankylosing spinal disorders (ASD), such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), with the hypothesis that complication and mortality rates are high.


BACKGROUND
Spine fractures in patients with ASD are unique and have only been described in relatively small case series.


METHODS
Retrospective review of a large consecutive series of patients with spine fractures and ASD over a 7-year period. Complications were stratified according to parameters such as type and number of comorbidities, patient age, and mechanism of injury. Predictors of mortality were analyzed by linear regression. Similarities between patients with AS and DISH were evaluated by chi analysis.


RESULTS
Of the 122 spine fractures in 112 consecutive patients with ASD, the majority were transdiscal extension injuries, most commonly affecting C6-C7. Eighty-one percent of the patients had at least 1 major medical comorbidity. Spinal cord injury was present in 58% of the patients, 34% of whom improved by at least 1 American Spinal Injury Association grade. Nineteen percent of patients had delayed diagnosis of their spine fracture, 81% of whom had resulting neurologic compromise. Surgery was performed on 67% of patients, consisting primarily of multilevel posterior instrumentation 3 levels above and below the injury. Eighty-four percent of all patients had at least 1 complication. Mortality was 32% and correlated with age > or =70 (P < 0.0001), number of comorbidities (P < 0.0001), and low-energy mechanism of injury (P = 0.009). AS patients were younger (P = 0.03) and had a higher risk of delayed fracture diagnosis (P = 0.012), but were otherwise similar to DISH patients.


CONCLUSIONS
Patients with spine fractures and ASD are at high risk for complications and death and should be counseled accordingly. Multilevel posterior segmental instrumentation allows effective fracture healing. AS and DISH patients represent similar patient populations for the purpose of treatment and future research.
Caron
Troy
T
Department of Orthopaedic Surgery, UT Southwestern Medical Center at Dallas, Dallas, TX, USA.
Bransford
Richard
R
Nguyen
Quynh
Q
Agel
Julie
J
Chapman
Jens
J
Bellabarba
Carlo
C
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications* / Q000000981:diagnostic imaging; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000000981:diagnostic imaging