Review Question - QID 1690

Patients with ankylosing spondylitis are prone to spinal fracture due to their rigid spine.

The most common fracture pattern seen are extension-type fractures of the cervicothoracic junction. These fractures can appear nondisplaced or minimally displaced initially, making them difficult to diagnose. The vertebral bony anatomy of patients with AS make them vulnerable to epidural bleeding. In this case, the MRI scan reveals an dorsal epidural hematoma that is leading to cord compression. Because the patient has a a progressive neurological deficit and radiographic evidence of compression treatment should include surgical decompression. Because the source of compression is posterior, a posterior laminectomy is treatment of choice. These fracture patterns are usually unstable so decompression should be combined with an instrumented fusion.

The Weinstein reference is a retrospective review of 105 patients with ankylosing spondylitis (AS) diagnosed over a 6-year period. They argue that in patients with cervical trauma and a progressive neurologic deficit, early diagnosis and appropriate therapy to decompress, reduce, and immobilize unstable spinal fractures may result in reduction of the mortality rate and permanent neurological deficits.