Spinal Cord Injury and Spinal Fracture in Patients with Ankylosing Spondylitis

Abstract

Objective: To determine the frequency, patterns, and neurological outcomes of spinal fractures and spinal cord injury (SCI) in patients with ankylosing spondylitis (AS) presenting at Khyber Teaching Hospital, Peshawar. Methodology: Patients with a confirmed diagnosis of ankylosing spondylitis presenting with spinal fractures were included. Demographic details (age, gender, disease duration, comorbidities) were recorded. Radiological evaluation (X-ray, CT, MRI) confirmed the type and location of fractures, while neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale. Data were analyzed using SPSS v.27. Frequencies and percentages were calculated for categorical variables, while means ± SD were reported for continuous variables. Chi-square and t-tests were applied to determine associations, with p-value < 0.05 taken as significant. Results: A total of 72 patients (mean age 52.4 ± 11.3 years; 80.6% male) were studied. Cervical fractures were most common (56.9%), followed by thoracic (23.6%) and lumbar (19.4%). Spinal cord injury occurred in 54.2% of cases, with incomplete deficits (61.5%) more frequent than complete paralysis (38.5%). Longer disease duration (>10 years) was significantly associated with fracture occurrence (p = 0.031), while CT confirmed all fractures and MRI identified cord compression. Conclusion: Patients with ankylosing spondylitis are at high risk for unstable spinal fractures and spinal cord injuries, particularly in the cervical region. Early imaging, vigilant clinical assessment, and multidisciplinary management are critical to improving outcomes. Greater awareness and preventive strategies are urgently needed in Pakistan to reduce morbidity and disability in this vulnerable population.

Keywords: Ankylosing spondylitis, spinal fracture, spinal cord injury, ASIA scale, Pakistan.