Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis

Objective:To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis (AS)and the effect of combined anterior and posterior operation. Methods:Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006.The symptom duration of AS was 14.5 years on average.Three cases had undergone osteotomy in lumbar spine.There were 4 cases of Grade A,3 cases of Grade B,9 cases of Grade C and 2 cases of Grade D according to Frankel’s score.There were 15 cases of GradeⅢdislocation and 3 cases of GradeⅡ.All patients underwent surgical procedures by combined anterior and posterior approach. Results:There were 4 anterior-posterior procedures,8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures.Seven patients had one stage operation and 11 cases underwent two stage surgeries.There was certain extent of neurological improvement in 14 incomplete paraplegic patients,but no improvement in 4 complete paraplegic patients.The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions:The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately.It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.