gms | German Medical Science

Objectives: To summarize the injury types and characteristics of patients with upper cervical spine injury secondary to ankylosing spondylitis, and to discuss the treatment strategies.

Methods: This study retrospectively analyzed the medical records of patients with upper cervical spine injury secondary to ankylosing spondylitis who visited our hospital from October 2010 to February 2023. There were 17 males and 2 females, with an average age of 54.8±8.4 years. Group A is the treatment group for fractures and dislocations that combined with severe neurological injuries (grade A and B), or with normal alignment. Group B is named the fractures and dislocations combined with coexisting deformity. Based on patient condition, location and severity of the deformity, Group B can be further divided into two groups: B1 and B2. Group B1 consists of fractures and dislocations combined with cervical, cervicothoracic deformities which are simultaneously treated for trauma and deformity. Group B2 consists of fractures and dislocations combined with thoracolumbar deformities which are treated for trauma and deformity at one-stage or staging surgery. The preoperative and postoperative C0–C2 angle, C1–C2 angle, cervical lordosis angle (CL), and cervicothoracic kyphosis angle (CT),thoracic kyphosis angle (TK), lumbar lordosis angle(LL), head tilt angle (HT), atlantoaxial rotation angle (AR), chin-brow vertical angle (CBVA), cervical sagittal vertical axis (CSVA), sagittal vertical axis (SVA), Pelvic Incidence (PI), Pelvic Tilt (PT) were measured. The clinical efficacy was evaluated using ASIA, visual analogue scale (VAS) and Neck Disability Index (NDI).

Results: Among the 19 patients, 3 patients only showed atlantoaxial dislocation without fractures. Among fresh injuries, 1 case was atlas fracture combined with odontoid fracture, and 10 cases were axis fracture. The old injuries included 5 cases with odontoid fractures and 3 cases with atlantoaxial dislocation. There were 9 patients in Group A, 3 patients in Group B1, and 5 patients in Group B2. The ASIA level, NDI score, and neck VAS score after surgery has obvious significant improvement. All fractures and the osteotomy site achieved grade I healing at the one-year follow-up. There was no neurological worsening, internal fixation loosening or breakage during the follow-up period.

Conclusion: Surgical treatment is an effective treatment for upper cervical spine injury in AS. Based on the patient’s preoperative injury, neurological function, and potential coexisting deformities, a comprehensive surgical treatment strategies was developed in order to balance the treatments between upper cervical spine trauma and potential coexisting deformities in a reasonable manner.