Skip to main content
NCBI home page
BMC Musculoskeletal Disorders logoLink to BMC Musculoskeletal Disorders
. 2026 Jan 7;27:96. doi: 10.1186/s12891-025-09459-1

Clinical effect of treating hyperextension injuries of the thoracolumbar spine in patients with ankylosing spondylitis, without active intervention on the anterior distraction defect

Zhiyuan Ye 1,2,#, Jian Yang 3,#, Xushen Zhao 1,#, Jinyu Bai 1, Fanglong Song 1, Jun Dai 1, Zhentao Zhou 1, Bingchen Shan 1, Xiaozhong Zhou 1,✉
PMCID: PMC12871018  PMID: 41501734

Abstract

Background

To observe the treatment effect of hyperextension fracture on thoracolumbar in patients with ankylosing spondylitis (AS) and determine whether anterior distraction defect can achieve union without active intervention.

Methods

From 2013 to 2023, we retrospectively searched our database to identify all individuals who had experienced extension-type fractures in the thoracolumbar region. The patients received either surgical or conservative management for treatment. The assessment of the extent of the anterior distraction defect was conducted in all patients. The evaluation of clinical effectiveness mainly involves the utilization of the visual analogue scale (VAS) to measure the severity of back pain and the Oswestry Disability Index (ODI) to assess functional limitations. Computed tomography imaging is used to assess the progress of fracture healing.

Results

A total of 32 individuals diagnosed with AS received medical treatment for thoracolumbar hyperextension fractures at our institution and met the inclusion criteria. All patients were followed up for a minimum of 12 months, with an average age of 58.7 ± 13.1 years. The mean extent of the anterior distraction defect was 10.3 (5.4, 16.1) mm, with 18 (56.3%) patients exhibiting an anterior defect extent exceeding 10 mm. All the patients expressed satisfaction with the outcomes, and all patients exhibited successful healing of their fractures. The mean VAS and ODI values were recorded as 1 (0, 2) and 9 (4, 9) %, respectively, during the final follow-up. Compared to surgery patients, the anterior defect was smaller in patients who received conservative treatment (P > 0.05). The anterior defect was larger after the operation compared to preoperative, but there was no statistically significant difference (P > 0.05). No significant complications or deaths occurred during the treatment, except for one patient who experienced a delayed neurologic deficit.

Conclusion

Regarding the anterior distraction defect resulting from hyperextension, fracture healing can be achieved without active intervention.

Keywords: Ankylosing spondylitis, Thoracolumbar fractures, Hyperextension injury, Distraction defect, Surgical stabilization, Conservative treatment

Introduction

Ankylosing Spondylitis (AS) is a chronic inflammatory disease characterized by biomechanical alterations of the spine and progressive stiffness [1]. In advanced AS, patients often develop ossification of soft tissue lesions, which leads to spine fusion, osteoporosis, spinal deformities, and produces a characteristic radiographic appearance known as bamboo spine [1, 2]. Therefore, patients with AS are more susceptible to sustaining fractures even with minimal energy mechanisms [3]. Due to the ankylosing ossification of the anterior and posterior elements, most fractures exhibit a significant degree of instability, affecting all three columns that comprise the spine [4, 5].

Hyperextension fractures are the most common type of thoracolumbar spine fracture in patients with AS [4–6]. According to the AOSpine classification, the incidence of B3-type fractures ranges from approximately 20% to 64% [2, 4, 7]. In these anterior distraction fractures, the two ends of the fracture are separated, resulting in the formation of an anterior distraction defect that may impede fracture healing [8]. Currently, surgical stabilization is the preferred treatment for managing thoracolumbar fractures in individuals diagnosed with AS [2, 4, 9, 10]. However, the efficacy of conservative treatment cannot be completely ignored as approximately one-third of patients choose it [11, 12]. Regardless of the treatment modality, achieving effective reduction of hyperextension fractures presents a considerable challenge due to the rigidity of the spine and pre-existing kyphotic deformity [5, 13]. Therefore, for anterior defects caused by distraction fractures, is bone graft fusion or active fracture reduction necessary?

It is well known that AS possesses a strong osteogenic ability, and adequate stabilization is crucial for the healing of fractures [14–16]. Some studies have also confirmed that anterior column defects can achieve bone union without the need for bone grafts or cages in AS patients with thoracolumbar pseudarthrosis [14, 17, 18]. Additionally, some studies have suggested that although achieving a reduction of hyperextension injury is challenging during surgery, postoperative mobilization can spontaneously restore the sagittal profile of the fracture and reduce the extent of the anterior defect by compressing the fracture site [5, 13]. However, for hyperextension fractures, few studies have reported the extent of the anterior distraction defect and whether natural union can be achieved.

The objective of this investigation was to assess the clinical and radiological outcomes following surgical stabilization or conservative treatment for hyperextension injuries affecting the thoracolumbar spine, without bone graft fusion or active fracture reduction for the anterior distraction defects. Additionally, it is questionable whether a patient with a large anterior defect can achieve union without active intervention. Therefore, we assessed the extent of the anterior defects caused by hyperextension injury to provide a reference for future clinical treatment.

Materials and methods

This study was retrospectively conducted at a single institution and received approval from the Institutional Review Board, with all patients providing informed consent. We retrospectively searched our database to identify all individuals who exhibited extension-type fractures in the thoracolumbar region between February 2013 and April 2023. Demographic data collected included age, gender, trauma history, fracture level, neurological status, and the extent of the anterior defect (Table 1). The diagnosis of AS was confirmed by the rheumatologist through a comprehensive evaluation, which included clinical observations and radiographic assessments. The fracture types were classified using the AOSpine classification. The evaluation of neurological disabilities was performed using the grading system developed by the American Spinal Injury Association (ASIA).

Table 1.

Patient demographics and case details

All participants Operative Nonoperative P value
No. of patients 32 21 11
Age (yr) 58.7 ± 13.1 61.3 ± 13.9 53.6 ± 10.2 0.118
Sex 0.593
 Male 28 19 9
 Female 4 2 2
Mechanism of injury 0.442
 Low-energy (e.g., ground-level fall) 21 15 6
 High-energy (e.g., high-speed MVA) 11 6 5
ASIA grade 0.695
 C 3 3 0
 D 1 1 0
 E 28 17 11
Anterior defect (mm) 10.3(5.4, 16.1) 12.7 ± 9.9 9.3 ± 4.6 0.289
Open in a new tab

MVA motor vehicle accident, ASIA  American Spinal Injury Association

The anterior distraction defect is defined as the line located at the anterior of the fractured end of the thoracolumbar spine or as the maximum height of the bony defect in sagittal view on CT scans [8, 17]. The treatment methods include surgical and conservative approaches. Surgical treatment is recommended for this type of thoracolumbar hyperextension fracture in AS, especially in patients with nerve damage; however, the final decision regarding treatment rests with the patient. Surgical treatment is mainly based on posterior long-segment surgical fixation, while conservative treatment generally includes three months of bed rest, bracing, and the use of anti-inflammatory drugs. For surgical patients, if there is no obvious postoperative pain, we generally recommend that they walk out of bed on the third day after surgery under the protection of braces. For non-surgical patients, we generally recommend that the bed rest time should not be less than 2 months, and we encourage patients to actively turn over and exercise their limbs in bed to prevent common complications of bed rest, such as pneumonia, bedsores, and urinary tract infections. The efficacy of anti-osteoporosis drugs as a treatment for secondary osteoporosis of AS has been found to be insignificant in various studies [19, 20]. Therefore, instead of routinely administering anti-osteoporosis therapy, we recommended that the patient receive further treatment for AS in the rheumatology department after fracture treatment.

Inclusion and exclusion criteria

The criteria for inclusion were as follows: (1) AS was diagnosed using the modified New York criteria; (2) the imaging findings were hyperextension fractures of thoracolumbar; (3) the patient received either surgical or conservative management for treatment; (4) patients were followed up, and imaging data was available. The criteria for exclusion were as follows: (1) the fractures were not hyperextension fractures of thoracolumbar; (2) the patient underwent an orthopaedic osteotomy and/or bone graft fusion; (3) the patients failed to follow up for various reasons.

Follow-up evaluation

The evaluation of clinical effectiveness mainly involves the utilization of the visual analogue scale (VAS) to measure the severity of back pain and the Oswestry Disability Index (ODI) to assess functional limitations. Bone healing is defined as the formation of bridging bone or the appearance of a trabecular pattern on computed tomography scans at the site of the fracture [4, 21]. Complications, including internal fixation failure in surgical patients, were recorded during treatment. The neurological status changes were assessed using the ASIA classification system.

Statistical analysis

Numerical values and percentages were used to present qualitative variables, whereas the mean ± standard deviation or median was employed to express quantitative variables. Differences in categorical variables were assessed using Pearson’s chi-square test. Preoperative and postoperative measurements were compared using paired sample t-tests, with a significance level set at P < 0.05. The statistical analyses were conducted using IBM SPSS Statistics 27.0 software.

Results

During the study period, a total of 36 individuals diagnosed with AS received medical treatment for thoracolumbar hyperextension fractures at our institution, and 32 (88.9%) of them met the inclusion criteria for this study. One patient (Fig. 1) had a dislocation before surgery, but the dislocation was completely corrected post-surgery. The extent of the defect in this patient is the largest among all cases, making it very meaningful for research and demonstration; therefore, we included this patient in the study. The average age was 58.7 ± 13.1 years (range 29–83 years). All patients were followed up for a minimum of 12 months, with an average follow-up duration of 55.9 ± 38.8 months. The majority of patients were males (87.5%), and low-energy injury (65.6%) was the primary mechanism of injury. Upon their hospital admission, four patients (12.5%) experienced varying degrees of neurological deficits, including three patients with ASIA C and one patient with ASIA D. The mean extent of the anterior distraction defect was 10.3 (5.4, 16.1) mm, with 18 (56.3%) patients exhibiting an anterior defect extent exceeding 10 mm.

Fig. 1.

Fig. 1

Open in a new tab

A 50-year-old man presented with a fracture of the L5 vertebrae resulting from a high-impact trauma. (A) Preoperative sagittal CT scan revealed a clear anterior separation of the L5 vertebral body. (B) The sagittal CT scan taken one week after the operation showed an improvement in fracture reduction and sagittal alignment. (C-D) The sagittal CT scan at 6 months and 12 months postoperatively demonstrated further improvement in fracture reduction. (E) The sagittal CT scan showed the healing of the fracture and the formation of a bone bridge at the fracture site 20 months after the operation. L, lumbar; CT, computed tomography

The surgical approach was employed in the treatment of 21 (65.6%) patients, while conservative management was used for 11 (34.4%) patients (Table 1). There were no significant differences between surgical and conservative treatments in terms of patient age, gender, mechanism of injury, neurological status, and extent of anterior defect (P > 0.05). However, we observed that the anterior defect was smaller in patients who received conservative treatment, and all patients with neurological deficits received a surgical approach. For surgical patients, the mean duration of the operation was 168.6 ± 53.3 min, and the mean blood loss was 310.5 ± 316.7 ml. The mean anterior defects were measured as 12.7 ± 9.9 mm preoperatively and 13.6 ± 9.2 mm postoperatively. Although the anterior defect was larger after the operation, there was no statistically significant difference (P > 0.05).

All the patients expressed satisfaction with the outcomes and were able to resume their daily lives independently. The VAS and ODI values obtained at the last follow-up were recorded as 1 (0, 2) and 9 (4, 9) %, respectively, and all patients exhibited successful fracture healing. All four patients with neurological deficits returned to normal at the last follow-up. No significant complications or deaths occurred during the treatment, except for one patient who experienced a delayed neurologic deficit and returned to normal after undergoing emergency spinal canal decompression.

Discussion

In patients with AS, when a fracture occurs, the spine tends to be displaced into hyperextension, and B3-type fractures are the most common type of thoracolumbar spine fracture [5, 22]. These fractures result in an anterior distraction defect, which increases instability and may impede the healing process [8]. The management of this type of fracture presents a significant challenge for healthcare professionals, whether they are involved in first aid, transportation, or the provision of care and treatment [23]. Additionally, although AS exhibits a strong ability for bone formation, further research is needed to determine whether the anterior distraction defect caused by hyperextension can heal naturally. Therefore, we conducted a retrospective analysis on 32 AS patients diagnosed with type B3 thoracolumbar fractures. The anterior defect was managed without bone graft fusion or active fracture reduction, and successful healing of fractures and positive clinical outcomes were observed in all patients.

The spinal fractures observed in AS patients primarily exhibit instability, affecting all three columns of the spine and often requiring surgical intervention [12, 24, 25]. However, the management of anterior distraction defects has been poorly documented in existing studies. Ye et al. [2] performed percutaneous long-segment fixation and utilized autologous bone block implantation for the anterior defect. Kai et al. [26] utilized hydroxyapatite to fill the disrupted defects in order to achieve support for the anterior column and believed that it is necessary to improve fracture reduction and sagittal alignment for the presence of obvious malalignment. Burke et al. [27] described that gradual reduction using a variable extension-distraction table is a safe and controlled method for achieving anatomical reduction. However, more research suggests that intraoperative reduction is extremely challenging for hyperextension injuries in ankylosed spines [5, 13, 23, 26]. Therefore, Lindtner et al. [5] proposed a new treatment concept in which fracture reduction through postoperative mobilization is deemed feasible, and the individual sagittal profile can be spontaneously restored. The data shows that fracture reduction occurs 3 weeks after surgical fixation using a soft rod, whereas it takes approximately 6 months when more rigid rods are utilized [5]. However, the study did not describe the extent of the anterior defect and whether fracture reduction can be achieved for larger distraction defects. In our study, we measured the range of anterior distraction defects, with more than half of the patients exhibiting an extent of anterior defect exceeding 10 mm, and the largest defect measuring 41.2 mm. Consistent with previous studies, we also did not achieve effective reduction during the procedure; instead, the data showed that the procedure actually exacerbated fracture distraction. Although we did not describe data on spontaneous fracture reduction after surgery, the postoperative review shows that some reduction in the anterior distraction defect was achieved (Fig. 1). Additionally, we also discovered that although surgery may worsen fracture distraction, patients with AS can still achieve fracture healing due to their strong bone formation ability (Fig. 2). This not only enhances anterior vertebral height but also partially corrects kyphosis in some patients (Fig. 3).

Fig. 2.

Fig. 2

Open in a new tab

A 69-year-old man presented with a fracture of the T12 vertebrae resulting from low-impact trauma. (A) Preoperative sagittal CT scan revealed a B3 type fracture of the T12 vertebra with a clear anterior separation of the vertebral body. (B) The sagittal CT scan taken one week after the operation revealed an increased anterior separation of the fracture. (C-D) The sagittal CT scan showed the formation of a bone bridge at the fracture site 7 months after the operation, and complete healing of the fracture was observed at 31 months after the operation. T, Thoracic; CT, computed tomography

Fig. 3.

Fig. 3

Open in a new tab

A 59-year-old man presented with fractures of the T12 and L1 vertebrae resulting from a high-impact trauma. (A) Preoperative sagittal CT scan revealed a clear anterior separation of the L1 vertebral body. (B) The sagittal CT scan taken one week after the operation revealed an increased anterior separation of the fracture. (C) The sagittal CT taken 4 years after the injury revealed that the fractures had completely healed. T, Thoracic; L, lumbar; CT, computed tomography

Nowadays, conservative treatment has gradually been marginalized due to its complications and poor outcomes [28, 29]. However, it remains in use for approximately one third of patients, primarily due to the increased risk of surgical complications [11, 12]. Bäcker et al. [30] believe that non-operative treatment is a feasible approach for patients with fused spines. Chen et al. [31] demonstrated that regardless of the treatment method, there were no significant differences in outcomes, suggesting that nonoperative management should receive more attention for the treatment of ankylosing spinal disorders with spine fractures. In our study, 34.4% of the patients chose conservative treatment. Compared to surgically treated patients, patients who underwent conservative treatment had no neurological damage and a smaller anterior defect, which could also be a reason for choosing conservative treatment. Similar to surgical fixation, the fractures in the conservative treatment group also healed effectively and exhibited restored sagittal alignment at the last follow-up (Fig. 4). Therefore, we believe that conservative treatment should not be overlooked, and further research is necessary to enhance its effectiveness.

Fig. 4.

Fig. 4

Open in a new tab

A 61-year-old man presented with fractures of the C7 and L1 vertebrae resulting from a high-impact trauma. He underwent surgery for the C7 fracture (red arrow) and opted for conservative treatment for the L1 fracture (white arrow). (A) The sagittal CT scan at 10 months after the injury revealed a B3 type fracture of the L1 vertebra with a clear anterior separation of the vertebral body. (B) The sagittal CT taken 7 years after the injury revealed complete healing of the L1 vertebral fracture. C, cervical; L, lumbar; CT, computed tomography

For our patients, clinical results were only recorded at the time of the last follow-up visit. Satisfactory outcomes were achieved in all patients. As we all know, complications associated with spinal fractures in patients with AS occur frequently, regardless of the treatment received, especially for elderly patients with pre-existing cardiopulmonary disease [30]. There is even a study that reports a mortality rate of 51% for conservative treatment and 32% for surgical treatment [32]. In our study, one patient who experienced a delayed neurologic deficit and returned to normal after undergoing emergency spinal canal decompression. The remaining patients did not experience any significant complications, and no deaths were recorded during the entire follow-up period. We analyzed the possible reasons for the good curative effect of this study as follows: First, the average age of patients in this study was 58.7 ± 13.1 years old, which was younger than in previous studies. Second, this study only included patients with AS combined with thoracolumbar fractures, excluding cervical fractures with higher complications and mortality rates. Third, with the development of medical technology, clinicians have a more in-depth understanding of AS combined with spinal fractures and can provide better and more reasonable treatment options. Fourth, due to the relatively low incidence of spinal fractures associated with AS, there may be some degree of chance and selection bias contributing to the high reported mortality rate in previous studies.

There were several limitations in our study. Firstly, it was a retrospective study that had the potential for selection bias. Secondly, we only presented the data of the latest follow-up without providing specific time of fracture healing in patients, which may vary depending on the extent of distraction defect. Thirdly, we solely described the bone healing status of patients and did not measure certain parameters before and after fracture healing, such as lordosis angle and anterior vertebral margin height. Despite the limitations in this study, the favorable clinical outcomes suggest that anterior distraction defects may undergo spontaneous healing without active intervention.

Conclusion

Regarding the anterior distraction defect resulting from hyperextension, fracture healing can be achieved without active intervention.

Acknowledgements

None.

Abbreviations

CT

Computed Tomography

AS

Ankylosing Spondylitis

VAS

Visual Analogue Scale

ODI

Oswestry Disability Index

ASIA

American Spinal Injury Association

Authors’ contributions

XZZ contributed to the study conception and design. ZYY, XSZ, FLS, and ZTZ contributed to clinical data collection; JY, JYB, and BCS contributed to radiological data analysis; ZYY and JD contributed to statistical analysis; ZYY, JY, and XSZ contributed to the writing and editing. All authors reviewed the manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (82172425), Jiangsu Provincial Medical Key Discipline (Laboratory) Cultivation Unit (JSDW202223), the Social Development Key Programs of Jiangsu Province-Advanced Clinical Technology (BE2023705), the Key Project of Scientific and Technological Innovation in China’s Nuclear Medicine (ZHYLTD2023001), and the cross-translation project for clinical innovation at Suzhou University (ML12301523).

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethics committee approval for this article was obtained from the Second Affiliated Hospital of Soochow University, with the number JD-HG-2023-74. Informed consent was obtained from all individual participants included in the study. The whole research process follows the Declaration of Helsinki.

Consent for publication

The patients provided informed consent for the publication of their document imaging, as well as their anonymous and clustered data.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Zhiyuan Ye, Jian Yang and Xushen Zhao contributed equally to this work and should be considered co-first authors.

References

  • 1.Bredin S, Fabre-Aubrespy M, Blondel B, Falguieres J, Schuller S, Walter A, et al. Percutaneous surgery for thoraco-lumbar fractures in ankylosing spondylitis: study of 31 patients. Orthop Traumatol Surg Res. 2017;103(8):1235–9. [DOI] [PubMed] [Google Scholar]
  • 2.Ye J, Jiang P, Guan H, Wei C, Li S, Jia M, et al. Surgical treatment of thoracolumbar fracture in ankylosing spondylitis: A comparison of percutaneous and open techniques. J Orthop Surg Res. 2022;17(1):504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Yeoh D, Moffatt T, Karmani S. Good outcomes of percutaneous fixation of spinal fractures in ankylosing spinal disorders. Injury. 2014;45(10):1534–8. [DOI] [PubMed] [Google Scholar]
  • 4.Trungu S, Ricciardi L, Forcato S, Miscusi M, Raco A. Percutaneous instrumentation with cement augmentation for traumatic hyperextension thoracic and lumbar fractures in ankylosing spondylitis: a single-institution experience. Neurosurg Focus. 2021;51(4):E8. [DOI] [PubMed] [Google Scholar]
  • 5.Lindtner RA, Kammerlander C, Goetzen M, Keiler A, Malekzadeh D, Krappinger D, et al. Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders. Arch Orthop Trauma Surg. 2017;137(4):531–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Barkay G, Apterman S, Ackshota N, Shtewe AH, Sissman E, Friedlander A. Early surgery for thoracolumbar extension-type fractures in geriatric patients with ankylosing disorders reduces patient complications and mortality. Spine J. 2023;23(1):157–62. [DOI] [PubMed] [Google Scholar]
  • 7.Westerveld LA, van Bemmel JC, Dhert WJ, Oner FC, Verlaan JJ. Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2014;14(5):729–40. [DOI] [PubMed] [Google Scholar]
  • 8.Borekci A, Kuru Bektasoglu P, Ramazanoglu AF, Hazneci J, Gurer B, Hakan T, et al. Surgical management thoracolumbar fractures in patients with ankylosing spondylitis: technical note with case series. World Neurosurg. 2023;176:3–9. [DOI] [PubMed] [Google Scholar]
  • 9.Li B, Guo R, Jiang X, Wu J, Zhang D, Yang C, et al. Posterior wedge osteotomy assisted by O-arm navigation for treating ankylosing spondylitis with thoracolumbar fractures: an early clinical evaluation. Ann Palliat Med. 2021;10(6):6694–705. [DOI] [PubMed] [Google Scholar]
  • 10.Buxbaum RE, Shani A, Mulla H, Rod A, Rahamimov N, Percutaneous. PMMA-augmented, pedicle screw instrumentation of thoracolumbar Ankylotic spine fractures. J Orthop Surg Res. 2021;16(1):317. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Robinson Y, Willander J, Olerud C. Surgical stabilization improves survival of spinal fractures related to ankylosing Spondylitis. Spine (Phila Pa 1976). 2015; 40(21):1697–702. [DOI] [PMC free article] [PubMed]
  • 12.Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009;18(2):145–56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Kohler FC, Schenk P, Bechstedt-Schimske M, Ullrich BW, Klauke F, Hofmann GO, et al. Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases. Eur J Trauma Emerg Surg. 2022;48(3):2297–307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Kou J, Guo J, Ji X, Tang X, Liu X, Sun Y, et al. A posterior-only approach for ankylosing spondylitis (AS) with thoracolumbar pseudoarthrosis: a clinical retrospective study. BMC Musculoskelet Disord. 2020;21(1):370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Chang KW, Tu MY, Huang HH, Chen HC, Chen YY, Lin CC. Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2006;31(13):E408–13. [DOI] [PubMed] [Google Scholar]
  • 16.Wang T, Wang D, Cong Y, Yin C, Li S, Chen X. Evaluating a posterior approach for surgical treatment of thoracolumbar pseudarthrosis in ankylosing spondylitis. Clin Spine Surg. 2017;30(1):E13–8. [DOI] [PubMed] [Google Scholar]
  • 17.Ye Z, Shan B, Wei X, Zhao X, Shan H, Zhou Z, et al. Clinical observation of posterior approach for surgical treatment of thoracolumbar pseudarthrosis in ankylosing spinal disorders. World Neurosurg. 2024;183:e963–70. [DOI] [PubMed] [Google Scholar]
  • 18.Shaik I, Bhojraj SY, Prasad G, Nagad PB, Patel PM, Kashikar AD, et al. Management of Andersson lesion in ankylosing spondylitis using the Posterior-Only approach: A case series of 18 patients. Asian Spine J. 2018;12(6):1017–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Liu J, Zhao L, Yang X, Liu C, Kong N, Yu Y, et al. Bone mineral density, bone metabolism-related factors, and microRNA-218 are correlated with disease activities in Chinese ankylosing spondylitis patients. J Clin Lab Anal. 2022;36(2):e24223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Eun IS, Park SH, Goh TS, Son SM, Kim DS, Lee JS. Effect of bisphosphonates on ankylosing spondylitis: A meta-analysis. J Clin Neurosci. 2021;92:153–8. [DOI] [PubMed] [Google Scholar]
  • 21.Ling T, Zhou B, Zhu C, Yang X, Song Y, Qiang Z, et al. One-stage posterior grade 4 osteotomy and bone graft fusion at pseudarthrosis for the treatment of kyphotic deformity with Andersson lesions in ankylosing spondylitis. Clin Neurol Neurosurg. 2017;159:19–24. [DOI] [PubMed] [Google Scholar]
  • 22.Sapkas G, Kateros K, Papadakis SA, Galanakos S, Brilakis E, Machairas G, et al. Surgical outcome after spinal fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord. 2009;10:96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Leone A, Marino M, Dell’Atti C, Zecchi V, Magarelli N, Colosimo C. Spinal fractures in patients with ankylosing spondylitis. Rheumatol Int. 2016;36(10):1335–46. [DOI] [PubMed] [Google Scholar]
  • 24.Lu AY, Blitstein JS, Talbott JF, Chan AK, Dhall SS, El Naga AN, et al. Single versus dual operative spine fractures in ankylosing spondylitis. Neurosurg Focus. 2021;51(4):E6. [DOI] [PubMed] [Google Scholar]
  • 25.Ren C, Zhu Q, Yuan H. Imaging features of spinal fractures in ankylosing spondylitis and the diagnostic value of different imaging methods. Quant Imaging Med Surg. 2021;11(6):2499–508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Kai K, Ikuta K, Masuda K, Kitamura T, Senba H, Shidahara S. Surgical outcomes of minimally invasive stabilization for spinal fractures in patients with ankylosing spinal disorders. Asian Spine J. 2018;12(3):434–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Burke JF, Tadepalli V, Chi J, Li XJ. Reduction and stabilization of an Extension-Distraction injury in a patient with ankylosing spondylitis: A case report. JBJS Case Connect. 2022;12(4):e2200368. [DOI] [PubMed] [Google Scholar]
  • 28.Lu ML, Tsai TT, Lai PL, Fu TS, Niu CC, Chen LH, et al. A retrospective study of treating thoracolumbar spine fractures in ankylosing spondylitis. Eur J Orthop Surg Traumatol. 2014;24(Suppl 1):S117–23. [DOI] [PubMed] [Google Scholar]
  • 29.Nakao Y, Sakuraba K, Harimaya K, Terada K, Kobara N, Kawaguchi KI, et al. Clinical features and outcomes of spine surgery in patients with ankylosing spondylitis. Mod Rheumatol. 2023;34(1):208–13. [DOI] [PubMed] [Google Scholar]
  • 30.Backer HC, Elias P, Hanlon J, Cunningham J, Johnson MA, Turner P. Spinal fractures in fused spines: nonoperative treatment is a reliable alternative. Arch Orthop Trauma Surg. 2023;143(9):5707–12. [DOI] [PubMed] [Google Scholar]
  • 31.Chen SR, Munsch MA, Chen J, Couch BK, Wawrose RA, Oyekan AA, et al. Spine fractures of patients with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis: fracture severity and Injury-Related mortality at a level I trauma center. Asian Spine J. 2023;17(3):549–58. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458–64. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Articles from BMC Musculoskeletal Disorders are provided here courtesy of BMC

RESOURCES