From circumferential to posterior-only fixation: evolving strategies for cervical fractures in ankylosing spinal disorders.
- 1Department of Neurosurgery, TUM School of Medicine and Health, Technical University Munich, Germany.
- 2Department of Neurosurgery, BG Trauma Center Murnau, Germany.
Abstract
Introduction
Cervical fractures in patients with ankylosing spinal disorders are highly unstable injuries associated with substantial morbidity and mortality. While surgical stabilization is widely accepted, the optimal surgical strategy remains debated.Research question
To evaluate surgical strategies, neurological outcomes, morbidity, and mortality following surgical treatment of cervical fractures in patients with spinal ankylosis.Material and methods
We retrospectively analyzed 91 consecutive patients with ankylosing spinal disorders who sustained cervical spine fractures and were treated surgically between 2008 and 2025. Demographic characteristics, fracture morphology, neurological status, surgical approach, perioperative outcomes, complications, and mortality were assessed.Results
The cohort comprised 91 patients with a median age of 78 years. Low-energy trauma accounted for most injuries. Neurological deficits were present in 28.6% of patients and were significantly associated with AO type C fractures and epidural hematoma. Surgical treatment consisted predominantly of posterior fixation, with a temporal shift from combined anterior-posterior stabilization toward posterior-only navigated pedicle screw constructs. Overall complication and in-hospital mortality rates were 52.7% and 9.9%, respectively. In multivariable Firth regression, higher Charlson Comorbidity Index remained associated with in-hospital mortality, whereas age did not.Discussion and conclusion
AO type C morphology and concomitant epidural hematoma were associated with neurological compromise. Posterior long-segment fixation using navigated pedicle screws became the predominant treatment strategy, with no mechanical failures requiring revision observed in this group during the available follow-up. Additional anterior stabilization remained important when direct anterior decompression or structural anterior column reconstruction was required.
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BibTeX
@article{backhaus2026from,
title = {{From circumferential to posterior-only fixation: evolving strategies for cervical fractures in ankylosing spinal disorders.}},
author = {Paul Backhaus and Nicole Lange and Alexander Lars Quiring and Bernhard Meyer and Maria Wostrack},
journal = {Brain \& spine},
year = {2026},
month = oct,
doi = {10.1016/j.bas.2026.107482},
url = {https://europepmc.org/article/MED/42960105},
note = {CC BY},
}
RIS
TY - JOUR
TI - From circumferential to posterior-only fixation: evolving strategies for cervical fractures in ankylosing spinal disorders.
AU - Paul Backhaus
AU - Nicole Lange
AU - Alexander Lars Quiring
AU - Bernhard Meyer
AU - Maria Wostrack
PY - 2026
DA - 2026/10/17
JO - Brain & spine
DO - 10.1016/j.bas.2026.107482
UR - https://europepmc.org/article/MED/42960105
AB - Introduction Cervical fractures in patients with ankylosing spinal disorders are highly unstable injuries associated with substantial morbidity and mortality. While surgical stabilization is widely accepted, the optimal surgical strategy remains debated.Research question To evaluate surgical strategies, neurological outcomes, morbidity, and mortality following surgical treatment of cervical fractures in patients with spinal ankylosis.Material and methods We retrospectively analyzed 91 consecutive patients with ankylosing spinal disorders who sustained cervical spine fractures and were treated surgically between 2008 and 2025. Demographic characteristics, fracture morphology, neurological status, surgical approach, perioperative outcomes, complications, and mortality were assessed.Results The cohort comprised 91 patients with a median age of 78 years. Low-energy trauma accounted for most injuries. Neurological deficits were present in 28.6% of patients and were significantly associated with AO type C fractures and epidural hematoma. Surgical treatment consisted predominantly of posterior fixation, with a temporal shift from combined anterior-posterior stabilization toward posterior-only navigated pedicle screw constructs. Overall complication and in-hospital mortality rates were 52.7% and 9.9%, respectively. In multivariable Firth regression, higher Charlson Comorbidity Index remained associated with in-hospital mortality, whereas age did not.Discussion and conclusion AO type C morphology and concomitant epidural hematoma were associated with neurological compromise. Posterior long-segment fixation using navigated pedicle screws became the predominant treatment strategy, with no mechanical failures requiring revision observed in this group during the available follow-up. Additional anterior stabilization remained important when direct anterior decompression or structural anterior column reconstruction was required.
SN - 2772-5294
ER -