Occult vertebral fractures in ankylosing spondylitis.

Abstract

A retrospective review of patients with ankylosing spondylitis involved in a blunt trauma. Patients referred to two Level I tra uma centers. To determine the incidence and clinical sequelae in thi s patient population where vertebral injury was diagnosed on a delayed basis. 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. 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. A high index of suspicion and an appreciation of the extreme instability of a fracture in ankylosing spondylitis must be present.