Bechterew's Disease and the Risk of Spinal Fractures: Clinical Patterns, Imaging Correlation, and Outcomes.

Bechterew's disease, or ankylosing spondylitis (AS), is a chronic inflammatory spondyloarthropathy that causes spinal rigidity and increases the risk of unstable fractures, often after low-energy trauma. This systematic review included seven studies encompassing 672 patients with ankylosed spines who sustained spinal fractures. Clinical presentation commonly involves sudden back or neck pain, kyphotic deformity, limited spinal mobility, and neurological deficits, which may be subtle and easily overlooked. Fractures predominantly affect the cervical spine (C5-C7) and thoracolumbar junction (T11-L2), often extending through all three spinal columns, resulting in high instability and risk of spinal cord injury. Accurate imaging is critical; computed tomography delineates bony injuries, while magnetic resonance imaging identifies spinal cord damage, ligamentous disruption, and epidural hematomas. Nonoperative management carries a high risk of secondary displacement and neurological deterioration, whereas early surgical stabilization, typically via posterior or combined anterior-posterior fixation, improves outcomes. Multidisciplinary care involving orthopedic, neurosurgical, and critical care teams is essential for optimizing recovery. Limitations of the current literature include small sample sizes and heterogeneous study designs. Future research should focus on prospective multicenter studies, standardized imaging and management protocols, and long-term functional outcomes to reduce fracture risk and improve care in this high-risk population.