Clinical effect of treating hyperextension injuries of the thoracolumbar spine in patients with ankylosing spondylitis, without active intervention on the anterior distraction defect

Background To observe the treatment effect of hyperextension fracture on thoracolumbar in patients with ankylosing spondylitis (AS) and determine whether anterior distraction defect can achieve union without active intervention. Methods From 2013 to 2023, we retrospectively searched our database to identify all individuals who had experienced extension-type fractures in the thoracolumbar region. The patients received either surgical or conservative management for treatment. The assessment of the extent of the anterior distraction defect was conducted in all patients. The evaluation of clinical effectiveness mainly involves the utilization of the visual analogue scale (VAS) to measure the severity of back pain and the Oswestry Disability Index (ODI) to assess functional limitations. Computed tomography imaging is used to assess the progress of fracture healing. Results A total of 32 individuals diagnosed with AS received medical treatment for thoracolumbar hyperextension fractures at our institution and met the inclusion criteria. All patients were followed up for a minimum of 12 months, with an average age of 58.7 ± 13.1 years. The mean extent of the anterior distraction defect was 10.3 (5.4, 16.1) mm, with 18 (56.3%) patients exhibiting an anterior defect extent exceeding 10 mm. All the patients expressed satisfaction with the outcomes, and all patients exhibited successful healing of their fractures. The mean VAS and ODI values were recorded as 1 (0, 2) and 9 (4, 9) %, respectively, during the final follow-up. Compared to surgery patients, the anterior defect was smaller in patients who received conservative treatment (P > 0.05). The anterior defect was larger after the operation compared to preoperative, but there was no statistically significant difference (P > 0.05). No significant complications or deaths occurred during the treatment, except for one patient who experienced a delayed neurologic deficit. Conclusion Both surgical and conservative treatments can achieve favorable outcomes in patients with AS accompanied by thoracolumbar hyperextension fracture. Regarding the anterior distraction defect resulting from hyperextension, fracture healing can be achieved without active intervention.