Traumatic Lumbar Fracture in Ankylosing Spondylitis: A Narrative Review With Case Illustration Publisher



Bagherzadeh S ; Jafari M ; Ehteshami S ; Roohollahi F ; Greenberg M ; Alikhani P ; Rostami M
Source: Iranian Journal of Neurosurgery Published:2025

Abstract

Background and Aim: Ankylosing spondylitis (AS) increases the risk of spinal fractures, often after minor trauma, due to fragile and rigid spinal anatomy. Lumbar fractures in AS patients are rare, and optimal management strategies are not well established. This study presents a case of traumatic lumbar spine fracture in an AS patient and reviews the current literature on diagnosis and management. Methods and Materials/Patients: A 48-year-old male with longstanding AS presented with a traumatic L2-L3 AO type C fracture and neurological deficits following a motorcycle accident. He underwent staged surgical management: First, multilevel posterior fixation, followed by anterior column reconstruction with cage placement. A literature review was conducted to collect evidence-based recommendations for managing such fractures. Results: The patient’s neurological function improved substantially following surgery, with progressive recovery of motor function and bladder control by three months. Literature review suggests that surgical intervention is generally preferred for unstable fractures in AS, with special attention required for anatomical challenges and perioperative risks. Conclusion: Lumbar spine fractures in AS often result from low-energy trauma and can present with subtle symptoms. Prompt diagnosis and individualized surgical management can lead to favorable outcomes, emphasizing the importance of careful perioperative planning in this unique patient population. © 2025 Elsevier B.V., All rights reserved.