[Objective] To explore the clinical risk factors of spinal fracture in patients with ankylosing spondylitis and the clinical effect of different operative methods. [Methods] From January 2014 to December 2018, 80 patients with ankylosing spondylitis were selected and divided into case group (n = 36) and control group (n = 44). The clinical data of the patients were reviewed and the clinical risk factors of spinal fracture in ankylosing spondylitis were analyzed. According to the operation mode, the case group was divided into bone cement group (n = 16) and bone grafting group (n = 20). The perioperative data and postoperative recovery of the two groups were compared. [Results] By single factor analysis, the proportion of patients with history of falling trauma was higher than that of control group, and the whole body bone mineral density was lower than that of control group. Age, course of disease, finger-to-ground distance and BASRI score were higher than those of control group (P<0.05). Multivariate analysis showed that history of falling trauma, age, course of disease, whole body bone mineral density (BMD) T-score, finger-to-ground distance and BASRI score were the shadows of spinal fracture in ankylosing spondylitis. Sound factor (P<0.05). Hospitalization time and bed rest time after operation in cement group were shorter than those in bone graft group (P<0.05). [Conclusion] The occurrence of spinal fracture in ankylosing spondylitis is closely related to many factors. The effect of internal fixation combined with pedicle screw graft or cement strengthening is significant.