In a patient with ankylosing spondylitis, a fall from standing or a minor knock can fracture the rigid spine, and plain films often miss it because of osteopenia and abnormal anatomy. New neck or back pain after any trauma should be treated as a fracture until proved otherwise. CT is the minimum, and MRI is often needed to show ligamentous and epidural injury. Because fractures can occur at more than one level, image the whole spine rather than only the painful region.
- Treat new spinal pain after minor trauma in ankylosing spondylitis as a fracture until imaging excludes it.
- Request CT of the whole spine, not plain films alone.
- Add MRI when CT is negative but pain persists or there is any neurological change.
- Immobilise in the patient's existing posture; never force a kyphotic neck into neutral alignment.
Why it matters
Missed fractures in the ankylosed spine can displace later and cause catastrophic cord injury.
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