Surgical management and outcomes of ankylosing spondylitis fractures in adults: a systematic review and meta-analysis.

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the vertebral column. Surgical management of traumatic spinal fractures in patients with AS is often the first line treatment, however it has a high risk of perioperative complications. This systematic review explored current operative techniques and their outcomes in patients with AS sustaining traumatic spinal fractures.

Methods: A PRISMA-compliant systematic review was conducted, and databases Embase, Pubmed/Medline and Cochrane were searched from inception to April 2024. Studies were included if they had complete individual patient data. Data was synthesized qualitatively and quantitatively. Univariate and multivariate logistic regression and ordinal regression was performed on R, to evaluate the relationship between surgical outcomes and independent patient and operative factors.

Results: Seven studies with complete individual patient data were included, involving 150 patients. Increasing age was a significant predictor of mortality (OR 1.08, 95% CI 1.04-1.13, p < 0.001) and post-operative complications (OR 1.07, 95% CI 1.04-1.10, p < 0.001). Fixation and decompression of the thoracic level was also strongly associated with higher complications (OR 6.4, 95% CI 1.28-40.14, p < 0.05). Single level compression improved post-operative ASIA outcomes (OR 0.43, 95% CI 0.17-0.97, p < 0.05). A higher pre-operative ASIA score (C, D or E) was related with improved post-operative neurological recovery.

Conclusion: This study emphasizes the impact of age, level of spinal involvement, and surgical approach on surgical outcomes of traumatic spine fractures in AS. Future randomised controlled trials in the field can help further refine surgical strategies and improve patient care.