Intact Posterior Tension Band in Spinal Fractures in Patients With Spinal Ankylosing Disorders - Is it a Myth or a Reality? A Systematic Review

Study DesignSystematic review.ObjectiveSurgery remains the gold standard in management of unstable spinal fractures in patients with spinal ankylosing disorders (SAD), especially in the presence neurodeficit. Certain studies have reported the effectiveness of non-surgical treatment in non-displaced and clinically stable fractures.MethodsOur systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted (15^th July, 2025) across 4 different databases to identify studies reporting outcomes of conservative treatment of spinal fractures in the context of ankylosed spine. The patients were subclassified as groups A (surgically-unfit) and B (stable fractures) for further analysis.Results13 studies (187 patients) were reviewed. The underlying etiology was DISH (diffuse idiopathic spinal hyperostosis) in 86.4%. Overall, cervical, thoracic/thoracolumbar (TL) and lumbar fractures were observed in 14.1%, 72.7% and 13.2%, respectively. There were 66% in group B; and a majority were neurologically intact (ASIA E: 97.3%). Different conservative strategies are described (combination of bed rest, orthosis and regular surveillance). Overall fracture healing was 69.5% (group A-47.1% and group B-91%). The morbidity and mortality in these fractures are high (particularly, group A). Halo-immobilization was associated with high complications (especially in debilitated individuals).ConclusionIn a selected group of patients with stable fracture patterns, conservative treatment is a viable management option in SAD patients with good healing rates. Based on our analysis of reviewed data, we have put forth criteria for decision-making and protocol for conservative management of these fractures.