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. 2011 Mar;20(3):403-7.
doi: 10.1007/s00586-010-1628-y. Epub 2010 Dec 3.

Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis

Fahim Anwar  1 , A Al-Khayer, G Joseph, M H Fraser, M V Jigajinni, D B Allan
Affiliations

Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis

Fahim Anwar et al. Eur Spine J. 2011 Mar.

Abstract

Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine fractures. Long-standing pain may mask the symptoms of the fracture. Radiological imaging of the cervical spine may fail to identify the fracture due to the distorted anatomy, ossified ligaments and artefacts leading to delay in diagnosis and increased risk of neurological complications. The objectives are to identify the incidence and risk factors for delay in presentation of cervical spine fractures in patients with AS. Retrospective case series study of all patients with AS and cervical spine fracture admitted over a 12-year period at Queen Elizabeth National Spinal Injuries Unit, Scotland. Results show that total of 32 patients reviewed with AS and cervical spine fractures. In 19 patients (59.4%), a fracture was not identified on plain radiographs. Only five patients (15.6%) presented immediately after the injury. Of the 15 patients (46.9%) who were initially neurologically intact, three patients had neurological deterioration before admission. Cervical spine fractures in patients with long-standing AS are common and usually under evaluated. Early diagnosis with appropriate radiological investigations may prevent the possible long-term neurological cord damage.

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Figures

Fig. 1
Fig. 1
Causes of cervical spine fractures in ankylosing spondylitis
Fig. 2
Fig. 2
Pattern of cervical spine injuries in ankylosing spondylitis
Fig. 3
Fig. 3
Plain radiograph the cervical spine with no obvious fracture
Fig. 4
Fig. 4
Swimmers view of the same patient with a suspicious lesion
Fig. 5
Fig. 5
CT with sagittal reconstruction in the same patient showing an obvious three-column fracture
See this image and copyright information in PMC

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