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A Comparison of Open and Percutaneous Techniques in the Operative Fixation of Spinal Fractures Associated with Ankylosing Spinal Disorders

Cara L. Sedney, MD, MA,1 Scott D. Daffner, MD,2 Abimbola Obafemi-Afolabi, MD,3 Daniel Gelb, MD,3 Steven Ludwig, MD,3 Sanford E. Emery, MD, MBA,2John C. France, MD2

1 Department of Neurosurgery; West Virginia University, Morgantown, WV, 2 Department of Orthopaedics, West Virginia University, Morgantown, WV, 3Department of Orthopaedics; University of Maryland, Baltimore, MD



The operative care of patients with ankylosing spinal conditions such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) after a spine fracture is not well represented in the literature. This work seeks to determine the effect of minimally invasive techniques on patients with spinal fractures and ankylosing spinal conditions through a retrospective case-control analysis.


The operative logs from 1996-2013 of seven fellowship-trained spine surgeons from two academic, Level I trauma centers were reviewed for cases of operatively treated thoracic and lumbar spinal fractures in patients with ankylosing spinal disorders.


A total of 38 patients with an ankylosing spinal condition and a spinal fracture were identified. The minimally invasive group demonstrated a statistically significant decrease in estimated blood loss, operative time, and need for transfusion when compared to either the hybrid or open group. There was no difference between the three subgroups in overall hospital stay or mortality. 


Patients with ankylosing spinal conditions present unique challenges for operative fixation of spinal fractures. Minimally invasive techniques for internal fixation offer less blood loss, operative time, and need for transfusion compared to traditional techniques; however, no difference in hospital stay or mortality was reflected in this series of patients. Level of Evidence: 4.

Clinical Relevance

Ankylosing spinal disorders are increasingly common in an aging population.

spinal fusion, Ankylosing Spondylitis, minimally invasive
Volume 10 Article 23