Practice Lesson of the Week

Clinical management of injured patients with ankylosing spondylitis

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2568 (Published 17 July 2009) Cite this as: BMJ 2009;339:b2568
  1. Steve Fordham, specialist trainee 5 emergency medicine,
  2. Gavin Lloyd, consultant emergency physician
  1. 1Royal Devon and Exeter Hospital, Exeter EX2 5DW
  1. Correspondence to: gavin.lloyd{at}rdeft.nhs.uk
  • Accepted 3 November 2008

Patients with ankylosing spondylitis are prone to low impact fractures. Maintain a low threshold for medical imaging

Ankylosing spondylitis has a prevalence of approximately 1 in 1000 in the UK.1 Up to 6% of these patients are estimated to experience a vertebral fracture during their lifetime.2 The incidence of major neurological complications following fracture is high (29-92%) with considerable associated morbidity and mortality.3 4 The rate of missed fractures in this population is not formally reported in the literature. We present four cases of missed spinal fracture in patients with ankylosing spondylitis and discuss the management of such patients.

Case reports

Case 1

A 60 year old man with a 30 year history of ankylosing spondylitis walked into the emergency department after a simple fall in his garden. He had sustained a minor head injury and tenderness was elicited in his upper thoracic spine. He was discharged home without x ray, but presented again 14 days later having developed numbness in his thumb, index, and middle fingers bilaterally. Plain x ray and computed tomography imaging showed an unstable fracture dislocation at the C6/7 level (fig1).

Fig 1 Unstable fracture dislocation …

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