title: Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach?
abstract: BACKGROUND
  Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures.
  
  
  METHODS
  A systematic review was undertaken using the keywords 'ankylosing spondylitis', 'spine fractures', 'cervical fractures', 'surgery' and 'postoperative outcomes' on Medline, Pubmed, Google Scholar, Ovid and Embase, and the quality of the studies included was evaluated according to the Coleman Methodology Score.
  
  
  RESULTS
  Surgery ameliorates neurological function in patients with unstable AS-related cervical fractures. The combined anterior/posterior and the posterior approaches are more effective than the anterior approach.
  
  
  RESULTS
  The optimal approach, anterior, posterior or combined anterior/posterior, for the management of AS related cervical fractures has not been defined.
  
  
  CONCLUSIONS
  Open reduction and internal fixation allows avoiding worsening and enhances neurological function in AS patients with cervical fractures.
  
  
  CONCLUSIONS
  Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions.
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
authors: Umile Giuseppe
authors: UG
authors: Longo
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
authors: Mattia
authors: M
authors: Loppini
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
authors: Stefano
authors: S
authors: Petrillo
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
authors: Alessandra
authors: A
authors: Berton
authors: Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy n.maffulli@qmul.ac.uk.
authors: Nicola
authors: N
authors: Maffulli
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
authors: Vincenzo
authors: V
authors: Denaro
mesh_terms: D001368:Axis, Cervical Vertebra / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D011183:Postoperative Complications; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D013167:Spondylitis, Ankylosing / Q000150:complications*; D016896:Treatment Outcome
keywords: ankylosing spondylitis; cervical fractures; management; postoperative outcomes; spine fractures; surgery