Objectives To study cervical spine involvement in ankylosing spondylitis (AS) and evaluate correlations with disease symptomatic and structural severity.

Methods Prospective evaluation of AS during one year. Clinical, biological, and radiological data were collected. The risk of CS involvement was estimated using Kaplan-Maier?s method.

Results 61 patients were enrolled: 38 males (62.2%) and 23 females of mean age 35.1 yrs (11) [range 17–66]. The mean disease duration was 10.6 yrs (7) [0.5–30]. Forty three patients (70.4%) had history of neck pain. Radiological involvement was present in 33 cases (54%). The concordance between clinical and radiological presentation was statistically significant (k = 0.49; p < 1–6). The risk of the cervical spine involvement with regard to disease duration showed that 19.6% of patients had radiological involvement after 5 years of disease duration, 29.9% after 10 years, 45.1% after 15 years and 70.0% after 20 years. Comparison between patients with and without cervical spine radiological involvement showed no difference in age of onset or sex. There was statistical difference in symptomatic severity parameters (Schöber, chest expansion, BASMI, BASFI, BASDAI, BASG) and structural severity parameters (lumbar syndesmophytes score, BASRI). There was a significant correlation between cervical spine radiological scores (facet joint score and BASRI) and age, disease duration, and symptomatic severity indexes (chest expansion, Schober, BASMI, BASFI) and disease activity index (BASDAI).

Conclusion Cervical spine involvement increases with age and disease duration in AS. Its severity is correlated to symptomatic and structural severity indexes of the disease.