In-Hospital Neurologic Deterioration Following Fractures of the Ankylosed Spine: A Single-Institution Experience

ObjectiveTo determine the rate and severity of in-hospital neurologic deterioration following vertebral fractures of spinal hyperostosis.MethodsA retrospective review of 92 fractures in 81 patients with diffuse idiopathic skeletal hyperostosis (42%) or ankylosing spondylitis (58%) was performed. Data on demographics, comorbidities, and fracture and treatment characteristics were recorded. Neurologic presentation and outcomes were categorized using American Spinal Injury Association grades and the modified Rankin Scale. Univariate and multivariate analyses were used to identify risk factors for neurologic deterioration or poor outcome (modified Rankin Scale 4–6).ResultsMost fractures (66%) occurred after falls of standing height or less. Presentation was delayed in 41% of patients (median 7 days), and diagnosis was delayed in 21% (median 8 days). Most fractures were extension (60%) or distraction (78%) injuries involving all 3 spinal columns. Median Subaxial Cervical Spine Injury Classification and Thoracolumbar Injury Severity Scale scores were 6 (interquartile range 5–7) and 7 (interquartile range 6–8), respectively. Of patients, 62% underwent open operative fusion either as initial therapy or after failed conservative treatment, 20% had percutaneous instrumentation, and 27% were treated in an external orthosis (52% required open fusion). Neurologic deterioration after presentation occurred in 7 patients (8.6%); 5 of these patients deteriorated after surgical treatment, constituting a 7.6% surgical risk. The presenting American Spinal Injury Association grade and patient age predicted poor outcome at 1-year outcome (P < 0.001). Death occurred in 17 patients within 1 year of injury (23%).ConclusionsNeurologic deterioration during the initial hospitalization after spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis is common, and 1-year mortality is high.