Fracture Stabilization and Ankylosing Spondylitis

Medically Reviewed by Tyler Wheeler, MD on August 09, 2022
5 min read

Inflammation that doesn’t go away can change the structure of your spine. And if you have ankylosing spondylitis (AS), there’s about a 5% to 15% chance you may have a spinal fracture at some point in your life.

AS can cause spinal fractures for several reasons. You may get osteoporosis, which weakens your bones. And the disks in your spine can harden and become less flexible. Long bones that can’t bend are more likely to break, kind of like a brittle stick.

Surgery can help stabilize a spinal fracture in ankylosing spondylitis. Your doctor will help you decide if it’s right for you. Here are some questions to get you started.

These breaks tend to happen most often in the cervical spine, or your neck area. But you can also get them in your thoracic or lumbar spine. That’s your middle and low back.

An unstable spinal fracture can snap in two. The broken bone or bones may pinch your spinal cord. That’s dangerous because the spine protects key nerves that send signals to your brain and body. These messages control things like sensation, movement, heart rate, and breathing.

Injury to your spinal cord can interrupt these signals. You may get pain or weakness. You could die. Surgery is a fast way to protect your spinal cord while your fracture heals.

The most common treatment is a spinal fusion. That’s when your doctor uses strong supports to stabilize your spine from the inside.

That might include:

  • Screws
  • Rods
  • Plates
  • Titanium cages
  • Bone grafts

Your doctor may also “decompress” your spinal cord and nerves while they’re in there. That can ease pressure from stenosis, or a narrowing of your spine. As a result, you may have fewer symptoms like pain, numbness, pins and needles, or weakness in your arms and legs.

There are different ways your doctor may do this kind of surgery. They’ll consider:

  • Where your fracture is located
  • Other health conditions you might have
  • The quality of your bones

They may also have a personal preference for one approach over another.

Surgery for fracture stabilization may include:

Posterior spinal fusion. This is when a surgeon stabilizes your spine from the back. It’s the most common way to treat a fracture in people with AS. It’s usually easier to align your spine from this angle.

Anterior spinal fusion. Sometimes doctors treat spinal fractures from the front. But surgeons usually don’t use this approach alone.

Combined 360 spinal fusion. This is a posterior-anterior approach. Simply put, it’s when a surgeon makes cuts from the back and front. And you may get screws and rods on both sides of your fracture.

Your doctor may decide you need surgery right away. They’ll let you know how to prepare. You may need to stop taking medication like blood thinners. And you’ll probably need to stop eating or drinking after midnight before you have surgery.

You’ll be asleep for the surgery, which can take a few hours or longer. You may have some pain when you wake up in the recovery room. Your doctor can give you some medication to feel better. Expect to stay in the hospital at least for a couple of days.

Everyone is different. But after surgery, you may:

  • Wear a soft or hard cervical collar for a short time
  • Wear some kind of back brace for a little while
  • Get physical or occupational therapy

It can take your body 3 months or so to recover from a spinal fusion. During that time, a health care professional will show you how to move safely. Make sure to keep any follow-up visits with your doctor. They’ll want updated X-rays to make sure your spine is healing the right way.

Nerve damage is the biggest worry. But your doctor will take strict spinal precautions. They’ll be extra careful when they move your body. That includes when they place you on the operating table and position you for surgery.

In general, the pros of surgery for fracture stabilization far outweigh the cons. But there are risks to any procedure. Your doctor should go over anything that might happen in the short or long term.

Besides nerve damage, other complications of a spinal surgery may include:

  • General infection
  • Lung infections, like pneumonia
  • Bleeding
  • Blood clots
  • Breathing problems

Surgery is the best way to stabilize a spinal fracture, especially in your cervical spine. It’s rare for a doctor to consider an operation too risky. But it may happen. For example, some people may have bodies that are too sick to handle a spinal surgery.

Unstable spinal fractures can be life-threatening. If you or your doctor decide against surgery, you’ll likely get treatment with brace immobilization. That’s when you wear something to keep your spine from moving when you stand or walk.

You'll also need to avoid exercises or movements that use your back a lot. And you may need to go on bed rest.

Nonsurgical treatments aren’t commonly recommended. But if your doctor decides that’s OK for you, they might suggest you wear one of the following for several months.

  • Halo vest
  • Cervical or back brace

Your fracture might get better without surgery. But AS can make it harder for your bones to heal. And without fast treatment, your odds of nerve damage or serious injury go up.

Call your AS doctor if you have new symptoms of pain or weakness. Check in even after a minor trauma, including a fall that may not seem like a big deal. They’ll want to run some tests to check if your spine is OK.

Some people with AS get a spinal fracture without any kind of trauma. But they commonly happen because of things like:

  • Falls while walking or standing
  • Bicycle crashes
  • Traffic accidents

Early on, it can be hard to tell the difference between a mild spinal fracture and other symptoms of AS. You’ll need a CT or MRI scan to know what’s going on. It’s hard to see these kinds of fractures on a regular X-ray.

If you do have a fracture, your doctor can refer you to a spinal surgeon. Make sure you see someone who treats a lot of people with AS. They’ll help you find the right treatment plan for you.