Spine Fracture in Ankylosing Spondylitis
Sagittal CT demonstrating a hyperextension fracture-dislocation through a completely ankylosed cervical spine at C6-7 in a patient with ankylosing spondylitis. The fracture extends through the fused disc space and facets (three-column injury). There is posterior displacement with likely epidural hematoma. The remainder of the spine shows complete ankylosis with bridging syndesmophytes.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Describe the imaging findings and why is this injury pattern unique?
What are the special considerations in managing AS spine fractures?
What investigations are required and what are you looking for?
Describe your management algorithm and surgical approach.
What are the technical considerations for surgical fixation?
What are the expected outcomes and complications?
Must Mention
- •Three-column injury (long bone analogy)
- •Low-energy mechanism
- •CT entire spine (5-10% have second fracture)
- •MRI for epidural hematoma (30-40%)
- •Surgical stabilization preferred
- •Long constructs (3-4 levels each side)
- •Careful handling (fragile spine)
- •Awake fiberoptic intubation if cervical
Common Pitfalls
- •Underestimate severity
- •Miss second fracture
- •Miss epidural hematoma
- •Short constructs
- •Rough handling
- •Delayed surgery
- •Forced positioning