Surgical Management of Fractures in Vertebrae with Ankylosing Spondylosis- A Systematic Review with Newer Principles of Management
Author(s): Suhasish Ray, Jha D K, Bikramjit Gayen
Ankylosing Spondylosis denotes seronegative arthritis that causes inflammation and eventual fusion of the spine and the spinal joints. Involvement of peripheral joints and extraarticular manifestations. it includes-Ankylosing spondylitis (AS); (DISH); End-stage spondylosis multiform (EASM); Ossified posterior longitudinal ligament (OPLL). The prevalence ranges from 0.1 to 1 percent of the population, M>F, between15- 40 years; 95% share the genetic marker HLA-B27. Numerous bony changes to spine include-Intraosseous bone loss; erosion; sclerosis; fractures; extra osseous squaring; syndesmo and enthesophytes . Incidence of ASVF is 3.5 times more than in general people, 75% in the cervical spine followed by thoracic and lumbar spine. There is 11 times more chance of Spinal cord injury than in general. Mean age of fracture is 63.4 years. Treatment is challenging due to kyphosis, osteoporosis, associated comorbities and cardiopulmonary restrictions. Treatment goals are to reduce or prevent- inflammation, ankylosis, abnormal posture. The principle is to treat the fracture as long bone osteoporotic diaphyseal fracture. Apart from 360* fracture fixation with long construct, MIS surgery, other fracture managements in AS are deformity correction, laminectomy, laminoplasty, rhizotomy, neuromodulation. Complication rates are high,wound infections up to16%,pulmonary complications up to 63%, 23% mechanical complications among various reports. A standard guideline should exist for ASVF workup, management and complications appraisal.