[Unexpected back pain in the elderly ankylosing spondylitis patient]

A 63-year-old man with ankylosing spondylitis (AS) presented with persistent pain in his back after minor trauma. Radiographs revealed no acute pathology. Six weeks later an MRI scan was performed which showed a vertebral fracture at level Tiii with kyphotic deformity. Another 63-year-old male AS patient presented with back pain after minor trauma 10 days before presentation. At plain radiology a vertebral fracture of Tx was discovered. A third patient, an 83-year-old male AS patient complained about back pain after minor trauma; CT imaging revealed a Tx vertebral fracture. All three patients underwent surgical fixation and were discharged without major complications. In principle, an older patient with an established AS complaining of back pain must be regarded as having a fracture of the vertebral column until the contrary is proven, even in the absence of any recent history of trauma. This strategy can prevent major complication in these patients.