| Objective:To retrospectively analyze the clinical characteristics and surgical efficacy of lower cervical fractures in patients with ankylosing spondylitis(AS).Methods:To collect the clinical data of patients with lower cervical fractures in AS treated surgically at the Southern Hospital of Southern Medical University and the First Affiliated Hospital of Gannan Medical College from January 2013 to September 2021.Their clinical data were collected,including basic patient information,clinical presentation,imaging features and surgical approaches.To evaluate the changes of ASIA classification of spinal cord injury,VAS score and JOA score before surgery and at the last follow-up.Changes in cervical curvature and C2～C7 SVA were measured preoperatively and at the last follow-up.Implant fusion was assessed using the Bridwell fusion grade classification.Results:A total of 13 patients were enrolled.They were all males.The mean age was 51 years,ranging from 36 to 68 years.The mean time of disease progression was 19 years,ranging from 6 to 30 years.The mean follow-up was 21 months,ranging from 6 to 76 months.1 case reported experiencing no trauma,6 cases low-energy trauma,and 6 cases high-energy trauma.10 patients were diagnosed within 24 hours after injury,while the other 3 cases more than 1 week after injury.One case was combined with pulmonary contusion,and one case was combined with pneumothorax.There were 3 cases of single-segment injury,9 cases of two-segment injury,and 1 case of three-segment injury.6 cases of fracture were combined with dislocation.According to the AOspine lower cervical fracture classification,there were 1 case of A1 type,1 case of B1 type,5 cases of B3 type,and 6 cases of C type.ASIA score:4 cases of grade A,1 case of grade B,1 case of grade C,4 cases of grade D,and 3 cases of grade E before surgery;2 cases of grade A,2 cases of grade B,0 cases of grade C,1 case of grade D,and 8 cases of grade E at the last follow-up;VAS score decreased from 7.1 ± 2.5 before surgery to 3.8±1.8 at the last follow-up(P<0.01).JOA score improved form 7.9±5.9 preoperatively to 11.6 ± 5.5 at last follow-up(P<0.01).C2-7 Cobb angle showed no significant change between 18.20± 17.1°preoperatively and 18.5°± 9.6° at last follow-up(P=0.96);C2-C7 SVA showed no significant change between 2.0±1 cm preoperatively and 1.8 ± 0.8 cm at last follow-up(P=0.33).Implant fusion grade at the last follow-up:8 cases of grade I fusion,3 cases of gradeⅡ fusion,and 2 cases of grade Ⅲ fusion.Conclusions:Lower cervical fractures in ankylosing spondylitis are three-column injuries and prone to spinal cord injury mostly.Combined use of X-ray,CT and MRI is useful in assessing the fracture condition.The patient’s clinical presentation and imaging characteristics should be considered to select the surgical procedure and fixation segments for individualized treatment.The surgical approach includes anterior surgery,posterior surgery and combined anterior and posterior surgery.Early surgical decompression and stabilization of the spine is conducive to patients’rehabilitation. |
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