Background <p>Patients with ankylosing spondylitis (AS) are prone to spinal fractures with unique characteristics. This retrospective cohort study aimed to characterize the demographic and clinical features of spinal fractures in AS patients; analyze fracture patterns, including anatomical distribution, morphology, and association with spinal cord injury (SCI); and evaluate surgical approaches and their associated complications.</p> Methods <p>From January 1, 2017, to December 31, 2022, AS patients admitted with spinal fractures were enrolled. Demographic details, fracture characteristics, surgical interventions, and postoperative complications were systematically collected and retrospectively reviewed. Neurological status was graded using the ASIA Impairment Scale.</p> Results <p>In total, 43 patients were identified over 46 admissions (mean age 55.1 ± 11.9 years, 87% male). Cervical spine fractures were most prevalent (34.8%), and fractures spanning multiple spinal regions were observed in 11 cases (23.9%). SCI was documented in 16 cases (34.8%), with 56.3% classified as ASIA A. Patients with SCI had significantly higher rates of in-hospital complications than those without SCI (62.5% vs. 10.0%, <i>p</i> = 0.001). Respiratory complications were most common (26.8% of all complications). Instrumentation failure requiring revision occurred in 4.9% of surgically treated patients; both cases involved failure of the anterior fixation—one after anterior‑only and the other after combined anterior‑posterior cervical surgery.</p> Conclusions <p>AS patients are at high risk for spinal fractures and associated SCI, particularly in the cervical spine. The higher rate of postoperative complications in patients with SCI highlights the critical need for enhanced perioperative monitoring. The potential risk of instrumentation failure with anterior fixation warrants further investigation.</p>