Management of cervical fractures in ankylosing spondylitis: a ten-year systemic review of surgical and nonsurgical outcomes

Cervical fractures in patients with ankylosing spondylitis (AS) are complex and carry significant morbidity and mortality due to the progressive rigidity and brittle bone characteristic of the disease. This meta-analysis highlights the management techniques and outcomes of cervical fractures in patients with ankylosing spondylitis over the past 10 years. A systematic review was conducted using databases such as PubMed, Cochrane Library, Scopus, and Web of Science, covering studies published between 2014 and 2024. Outcomes assessed included neurological outcomes, complications, mortality, reoperations, and length of hospital stay. The Joanna Briggs Institute (JBI) checklist was used to evaluate bias. Sixty-six (66) articles with 1972 patients were analyzed. The mean age of patients was 57.02 years, with a male-to-female ratio of 9.8:1, p < 0.001. Most fractures occurred at C6– C7 (36.66%) and C5– C6 (27.74%). Posterior fusion was the most commonly performed surgery (40.0%), followed by combined anterior-posterior fusion (28.3%), and anterior fusion (22.9%). Nonsurgical management was reported in 8.8% with a failure rate of 1.2%. The reoperation rate was highest in the anterior fusion group (11.1%), and lowest in the combined fusion group (1.7%). Good neurological outcomes were observed in 63.4% of cases, while poor outcomes were noted in 33.7%. The overall mortality rate was 2.9%. Cervical fractures in ankylosing spondylitis present significant challenges due to spinal rigidity, altered biomechanics, and high complication risks. Posterior fusion remains the most utilized approach, while combined anterior-posterior fusion demonstrates lower reoperation rates. Conservative management, including external immobilization, is viable for carefully selected stable fractures. Prospective studies with standardized outcomes are essential to optimize treatment strategies and enhance patient outcomes. © 2025 Elsevier B.V., All rights reserved.