{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:31:15Z","timestamp":1781782275690,"version":"3.54.5"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Ankylosing spondylitis, the most common spondyloarthritis, fuses individual spinal vertebrae into long segments. The unique biomechanics of the ankylosed spine places patients at unusually high risk for unstable fractures secondary to low-impact mechanisms. These injuries are unique within the spine trauma population and necessitate thoughtful management. Therefore, the authors aimed to present a richly annotated data set of operative AS spine fractures with a significant portion of patients with simultaneous dual noncontiguous fractures.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Patients with ankylosing spondylitis with acute fractures who received operative management between 2012 and 2020 were reviewed. Demographic, admission, surgical, and outcome parameters were retrospectively collected and reviewed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n In total, 29 patients were identified across 30 different admissions. At admission, the mean age was 71.7 \u00b1 11.8 years. The mechanism of injury in 77% of the admissions was a ground-level fall; 30% also presented with polytrauma. Of admissions, 50% were patient transfers from outside hospitals, whereas the other half presented primarily to our emergency departments. Fifty percent of patients sustained a spinal cord injury, and 35 operative fractures were identified and treated in 32 surgeries. The majority of fractures clustered around the cervicothoracic (C4\u2013T1, 48.6%) and thoracolumbar (T8\u2013L3, 37.11%) junctions. Five patients (17.2%) had simultaneous dual noncontiguous operative fractures; these patients were more likely to have presented with a higher-energy mechanism of injury such as a bicycle or motor vehicle accident compared with patients with a single operative fracture (60% vs 8%, p = 0.024). On preoperative MRI, 56.3% of the fractures had epidural hematomas (EDHs); 25% were compressive of the underlying neural elements, which dictated the number of laminectomy levels performed (no EDH, 2.1 \u00b1 2.36; noncompressive EDH, 2.1 \u00b1 1.85; and compressive EDH, 7.4 \u00b1 4 [p = 0.003]). The mean difference in instrumented levels was 8.7 \u00b1 2.6 with a mean estimated blood loss (EBL) of 1183 \u00b1 1779.5 mL. Patients on a regimen of antiplatelet therapy had a significantly higher EBL (2635.7 mL vs 759.4 mL, p = 0.015). Overall, patients had a mean hospital length of stay of 15.2 \u00b1 18.5 days; 5 patients died during the same admission or after transfer to an outside hospital. Nine of 29 patients (31%) had died by the last follow-up (the mean follow-up was 596.3 \u00b1 878.9 days).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Patients with AS who have been found to have unstable spine fractures warrant a thorough diagnostic evaluation to identify secondary fractures as well as compressive EDHs. These patients experienced prolonged inpatient hospitalizations with significant morbidity and mortality.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2021.7.focus21329","type":"journal-article","created":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T07:53:54Z","timestamp":1633074834000},"page":"E6","source":"Crossref","is-referenced-by-count":8,"title":["Single versus dual operative spine fractures in ankylosing spondylitis"],"prefix":"10.3171","volume":"51","author":[{"given":"Alex Y.","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob S.","family":"Blitstein","sequence":"additional","affiliation":[{"name":"Touro University California, College of Osteopathic Medicine, Vallejo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason F.","family":"Talbott","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, San Francisco; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay S.","family":"Dhall","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf N.","family":"El Naga","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee A.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron J.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"DiGiorgio","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Rheumatology","first-page":"780","article-title":"Ankylosing spondylitis: an update","volume":"42","author":"Golder V","year":"2013","unstructured":"Golder V, Schachna L. 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