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Occult vertebral fractures in ankylosing spondylitis
J A Finkelstein1, J R Chapman, S Mirza
1Division of Orthopedic Surgery, Sunnybrook Health Science Center and The University of Toronto, Ontario, Canada.
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.