Spinal Trauma in Patients with Ankylosing Spinal Conditions

Ankylosing spinal conditions are a constellation of mixed conditions causing fusion of the spine. The most well recognized condition is ankylosing spondylitis (AS), which is a systemic chronic autoimmune spondyloarthropathy causing progressive spinal fusion. Fractures in ankylosed often occur following minor trauma and are typically not visible and at a high risk to be missed in standard x-rays. A high level of suspicion is therefore necessary and cross-sectional imaging such as CT or MRI must be obtained to confirm or rule out the diagnosis of a fracture. Pre-vertebral soft tissue swelling often can indicate an underlying bony injury. Close attention to the patients’ neurological status needs to be maintained due to the high rate of epidural hemorrhage. Fractures in ankylosing spinal conditions are typically unstable and delayed diagnosis or inadequate fixation can result into loss of alignment and a secondary neurologic deficit.