Fractures in Ankylosed Vertebra-Newer Approaches in Management
Ankylosing Spondylytis is a type of seronegative arthritis that causes inflammation and eventually of the spine and spinal joints within involvement of peripheral joints and extra articular manifestations.The prevalence ranges from 0.1 to 1 percent of the population, men: women:: 3:1 and commonly develops between 15 to 40 years. 95% of people with AS share the genetic marker HLAB 27.(1).The mean prevalence of AS per 10000 is 23.8 in Europe, 16.7 in Asia,31.9 in N.America and 7.4 in Africa (2). In India the prevalence is 0.07% (3).
In AS, the risk of vertebral fracture is increased. Diagnosis of vertebral fracture is not easy, although their clinical consequences in aggravating spine deformities (hyperkyphosis) and complications are increasingly recognized (Geusensetal.2007). In a study in France VF in AS was found as high as 17% (4). Fractures are common in AS spine following minor low-energy trauma because of alteration in the bone composition and biomechanical properties. The Ossification of the supportive ligaments and soft tissues make this fractures unstable and susceptible to displacement and neurological deficit.(5,6).Complication rates are high with 51% in AS patients with overall mortality rate within 3 months period is 17.7% in AS patients.8 - 13% of patients have multi-level fractures. Incidence of spinal cord injury is 11 times higher than the general population (7), the average age of fracture is 63.4yrs (8).The treatments Challenging, osteoporosis, associated with restrictive lung disease, and medical comorbidities.