Patients with ankylosing spondylitis (AS) are more prone to injuries of the cervical spine, even with minor trauma. Although the fractures are markedly unstable (meaning that they have a tendency to slip out of place after the correction of the fracture), nonsurgical treatment using a halo-thoracic plaster or jacket is a common approach.

Researchers J. Schroder and colleagues from the University of Munster and Universitatsklinikum in Germany evaluate three AS patients with cervicothoracic fractures of the spine to describe problems and complications involved with this form of treatment.

Two of the patients had pin track infections and pin protrusion through the skull, leading in one case to a brain hemorrhage. In the third patient, the halo had to be removed after eight months, just in time to prevent the pins from cutting through.

One patient required craniotomy (a surgical incision into the skull); one was resolved by local revision; one fracture united after the patient used a stiff collar for two years.

In conclusion, the researchers believe that halo treatment for cervical spine fracture in patients with AS is a challenging task for orthopedic surgeons and neurosurgeons.