Long-term functional and radiological outcomes among survivors of ankylosing spondylitis-associated cervical spine fractures: a cross-sectional follow-up study

Background Patients with ankylosing spondylitis (AS) are predisposed to unstable cervical spine fractures, often following low-energy trauma. While short-term outcomes have been described, long-term functional and radiological outcomes among survivors remain poorly characterized.Methods Survivor cohort study with combined retrospective and prospective case identification and cross-sectional long-term follow-up, including patients with AS-associated cervical spine fractures treated at a single regional neurotrauma center between 2010 and 2020. Surviving patients underwent cross-sectional long-term follow-up including patient-reported outcomes, neurological and functional assessment, and cervical CT imaging. Primary outcomes included Neck Disability Index, Numeric Rating Scale for neck pain, American Spinal Injury Association Impairment Scale (AIS), Karnofsky Performance Status, living status, and CT-based fracture healing.Results Among 144 patients with AS-associated cervical spine fractures, 102 were alive and eligible for follow-up; 97 completed assessments at a median follow-up of 4.2 years. Median Neck Disability Index was 16% (IQR 6-30). Most patients lived independently (80%), with median Karnofsky Performance Status 80 (IQR 70-90). Among patients with spinal cord injury, 50% recovered to AIS E and 71% improved by at least 1 AIS grade. Neck pain was generally mild (median Numeric Rating Scale 2), and CT demonstrated solid bony fusion in 96% of assessed cases.Conclusions Among long-term survivors, neck-related disability and pain were generally low, independence was preserved in most patients, and fracture healing rates were high.