The fused spine in ankylosing spondylitis is brittle and acts as a long lever, so fractures follow trivial falls, often through the whole column, and plain radiographs miss many. Neurological deterioration can come late, sometimes from an epidural haematoma or displacement during transfer.
Immobilise in the patient's usual posture rather than forcing a neutral position, image with CT, and add MRI if there is any neurological finding or CT is equivocal. Image the whole spine, as non-contiguous injuries occur.
- Treat new neck pain after minor trauma in ankylosing spondylitis as a possible fracture
- Immobilise in the patient's pre-injury posture, not in forced neutral
- Use CT rather than plain films, and MRI for any neurological sign
- Image the whole spine to look for a second injury
Why it matters
Missed fractures in the ankylosed spine can turn a walking patient into a tetraplegic one.
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