title: Surgical outcomes after traumatic vertebral fractures in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies.
  
  
  METHODS
  Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability.
  
  
  RESULTS
  A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases.
  
  
  CONCLUSIONS
  Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.
authors.affiliation: Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Seong-Bae
authors.initials: SB
authors.lastname: An
authors.affiliation: Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
authors.forename: Keung-Nyun
authors.initials: KN
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Dong-Kyu
authors.initials: DK
authors.lastname: Chin
authors.affiliation: Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Keun-Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Yong-Eun
authors.initials: YE
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Sung-Uk
authors.initials: SU
authors.lastname: Kuh
keywords: Ankylosing spondylitis; Spinal cord injury; Surgery; Trauma; Vertebral fracture