title: Single anterior approach for cervical spine fractures at C5-T1 complicating ankylosing spondylitis.
abstract: OBJECTIVE
  To evaluate the outcomes of anterior approach for cervical spine fractures at C5-T1 in patients with ankylosing spondylitis (AS) and study the problems encountered in diagnosis and treatment.
  
  
  METHODS
  Ten patients with AS (all males; mean age 43.7±9.4 years) underwent anterior surgeries to treat fractures at C5-T1. Skull tractions were performed on patients with fracture dislocation preoperatively. After operation, all the patients wore a cervical collar for 3 months. Plain radiographs at follow-up were reviewed. If bone fusion could not be confirmed on plain radiograph, CT scan was employed. The pre- and postoperative neurological statuses were evaluated according to the Frankel grading system. Problems encountered in diagnosis and treatments were analyzed.
  
  
  RESULTS
  The mean follow-up was 41.2±22.7months. After operation, the displacements of fractures were significantly reduced(P<0.05). Bone fusions were observed in 9 patients at final follow-up. Frankel grades improved by 1.0±0.7 grade (P>0.05). Posterior complications occurred in four patients, including implants failure (n=1), subsidence of cage (n=1), hoarse voice (n=1) and pneumonias (n=2). The patient with implants failure required revision surgery and anterior-posterior fixation. Patient with subsidence of the titanium cage achieved bone fusion with prolonged cervical collar immobilization.
  
  
  CONCLUSIONS
  The diagnosis and treatment of cervical spine fractures at C5-T1 in AS patients are challenging, with high risk of neurological compromise and postoperative complications. The single anterior approach followed by postoperative immobilization with a cervical collar can yield acceptable results if the cases are properly selected.
authors.affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Qunfeng
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Orthopedics, Qilu Hospital of Shandong University, People's Republic of China.
authors.forename: Yidong
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China. Electronic address: 792175366@qq.com.
authors.forename: Xuhua
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China. Electronic address: 94438728@qq.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Ni
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016103:Spinal Fractures / Q000601:surgery*; D013167:Spondylitis, Ankylosing; D013904:Thoracic Vertebrae / Q000293:injuries
keywords: Ankylosing spondylitis; Anterior approach; Cervical spine; Fracture; Surgery; Treatment