Outcome of Non-operative Treatment of Extension Fractures in Patients with Ankylosed Spines – A Case Series

David Yen1, *
1 Department of Surgery, Queens University, Kingston, Ontario, Canada

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© 2024 The Author(s). Published by Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Surgery, Queens University, Kingston, Ontario, Canada; Tel: 613-548-2545; 613-985-2312; Fax: 613-548-2518; E-mail:



Surgical treatment is the mainstay of management in patients having fractures in fused spines. However, these patients also tend to be older and have comorbidities resulting in increased morbidity and mortality with operative management. Therefore, there has been more recent interest in the risks and benefits of nonoperative treatment in these patients.


Extension pattern fractures have an intact posterior element hinge resulting in lower risk of translation. Therefore, we wanted to determine the outcome of nonoperative treatment of extension pattern fractures in patients with fused spines.


We conducted a retrospective review of all patients with fused spines having extension thoracolumbar fractures without neurologic deficit treated nonoperatively at a University Health Sciences Centre over an 8-year period.


We had a complete set of data for 14 patients. There was a morbidity rate of 29% and a mortality rate of 14%. All of our patients had a significant positive change in their Cobb angle, indicating closure of the fracture gap without translation in either the sagittal or coronal planes. Remodelling of the fracture lines was found in all 14 patients and in 11 there were also bridging osteophytes across the fracture. No patients developed neurologic deficits.


By demonstrating the successful healing of extension fractures treated nonoperatively with morbidity and mortality in keeping with that of reports of patients with fused spines managed operatively, we added support to conducting future randomized studies of operative versus nonoperative treatment in this patient population.

Keywords: Ankylosing spondylitis, Diffuse idiopathic skeletal hyperostosis, Ankylosed spine patients, Extension pattern spine fractures, Thoracolumbar fractures, Operative vs nonoperative treatment.