Occult vertebral fractures in ankylosing spondylitis

Abstract

Study design: A retrospective review of patients with ankylosing spondylitis involved in a blunt trauma.

Setting: Patients referred to two Level I tra uma centers.

Objectives: To determine the incidence and clinical sequelae in thi s patient population where vertebral injury was diagnosed on a delayed basis.

Summary of background data: The ankylosed spine is at increased risk for fracture and spinal cord injury. Radiological identification of injury is more difficult than in the normal spine.

Results: Over a 5 year period, 21 patients were identified with seven having an occult vertebral fracture not recognized as the primary injury or occurring as a second non-contiguous injury level. In these cases, delay in diagnosis of the occult injury was from 3 to 22 days. Development of secondary neurological deficits occurred in three patients.

Conclusions: A high index of suspicion and an appreciation of the extreme instability of a fracture in ankylosing spondylitis must be present.