Non-Operative Management for Patients With Spinal Ankylosing Disorders Presenting With Extension Type (AOSpine B3) Fractures-Our Experience with a Cohort of 40 Patients.

Abstract

Study design: Retrospective study.

Background: Non-operative treatment for patients with spinal ankylosing disorders presenting with extension type fractures (AOSpine B3) has been disregarded due to reports of poor outcomes including secondary fracture displacement and unacceptably high mortality rates. Recent studies have questioned the prevailing recommendation for surgical management, advocating for reconsideration of non-operative treatment in appropriate cases. We aim to further identify patient and radiographic factors favoring successful non-operative management.

Methods: A retrospective analysis was conducted using data from Royal North Shore Hospital spine consult database. Patients with AOSpine B3 fractures treated non-operatively between 2021-2023 were included. Demographic, clinical, and radiographic data were collected and assessed, including outcome analysis of specific fracture patterns.

Results: A total of 40 patients were treated non-operatively. 30 were deemed appropriate for non-operative management based on initial imaging assessment. Complications and 6-month mortality occurred in 13% of patients in this group. No patients failed non-operative management and good clinical and radiologic outcomes were observed in all patients on follow up. An additional 10 patients required surgery but were deemed medically unfit. Patients in this group were found to have a mortality rate of 80%.

Conclusions: Non-operative management appears feasible for selected patients with DISH and AOSpine B3 fractures of an osseous or osseous-discal pattern, without posterior vertebral wall/annulus involvement and an anterior opening of up to 6 mm. These findings suggest non-operative treatment with close clinical and radiological follow up for specific patients is a viable treatment method in this patient group.