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Andrew Kanawati, BSc, MBBS MSc (Hons) UNSW Mast Anat (UNE) FRACS (Orth),1Nicolas Dea, MD, MSc, FRCSC,2Parham Rasoulinejad, BHSc, MD, FRCSC, MSc, 3Christopher S. Bailey, MD, FRCSC, MSc,4

1 Clinical Fellow, London Health Sciences Centre Spine Program, London, ON.
2Spine Surgeon, Clinical Associate Professor of Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, BC.
3 Assistant Professor, Department of Surgery, Division of Orthopaedic Surgery, Schulick School of Medicine and Dentistry, The University of Western Ontario, London, ON.4 Orthopaedic Surgeon, Division of Orthopaedic Surgery, London Health Sciences Center, and Associate Professor, Dept. of Surgery, University of Western Ontario, London, ON.

CLINICAL TOOLS

Abstract: Ankylosing spondylitis is a seronegative spondyloarthropathy associated with HLA-B27. The main site of pathology is the enthesis (site of tendon insertion). The axial skeleton is affected primarily, with the sacroiliac joints initially involved, with the enthesopathy resulting in fibrosis, calcification and fusion of the sacroiliac joints and spine. There is a high incidence of spine fractures in patients with AS, and there is a high rate of missed fractures, therefore advanced imaging in the form of CT and/or MRI is necessary. Due to their highly unstable nature, surgical management of spine fractures in AS is preferable to non-operative care.
Key Words: Ankylosing spondylitis, spondyloarthropathy, sacroiliitis, spine fracture.

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The spine and sacroiliac joints are the primary site of pathology in AS.
The natural history of the disease causes eventual fusion and kyphosis.
Spinal fractures occur at a higher incidence in AS compared to general population.
There is a high rate of missed fractures, and secondary neurologic complications.
Advanced imaging (CT and/or MRI) is mandatory to rule out fracture, because of high false-negative results of plain radiography.
The patient’s kyphosis must be taken into account when applying full spine precautions for suspected fracture.
Patients must not be forced into extension as this may shift an initially non-displaced fractures.
Loss of flexibility and ankylosis of the spinal column results in long lever arms and behavior akin to a long bone, therefore fractures of the spine are highly unstable and usually require surgical stabilization.
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