Minor Neck Trauma in Chronic Ankylosing Spondylitis

Abstract

Long-standing ankylosing spondylitis may predispose a patient to serious cervical injury in the setting of minor trauma. Early diagnosis is essential to a favorable outcome. We report a 75-year-old man whose relatively minor trauma in the setting of AS resulted in a cervical fracture and callus formation, which masqueraded as a tumor. The patient developed neck pain, bilateral hypoglossal nerve palsy with dysarthria, and dysphagia that ultimately resulted in his death. This case illustrates progressive neurologic signs of gradual disarticulation of the skull from the cervical spine. The situation is considered of importance because it emphasizes the need for early recognition and possible intervention in the presence of hypoglossal symptoms. The specific combination of long-standing ankylosing spondylitis and minor trauma is one setting in which a clinician must be alerted. Early consideration of neck immobilization is emphasized.

A new mechanism of injury in ankylosing spondylitis

“…13,26,27 As a result, fractures can occur in any region of the spine, 11,12,17,26,28,29 and may be unstable if they occur in the lower cervical spine. 9,10,18,19,[30][31][32] In patients with AS, cervical spinerelated injury is largely attributed to traumatic hyperextension resulting from a fall or other accidental mechanism 9,10,18,19,30-32 but there are some reports suggesting the development of AAS in AS. 22,23 In 1979, Sorin et al 23 first described two cases with AAS as an early complication of AS.…”

Fatality from minor cervical trauma in ankylosing spondylitis

“…The risk of sustaining neurological deficits is higher than average and mortality is twice that observed with a similar fracture involving normal spines 2. Several cases with fatal outcome after minor falls have been described 2 – 4. Due to the potentially catastrophic neurological complications the importance of routine cervical spine immobilisation in all trauma patients is recommended 5…”

Clinical aspects of cervical spine traumatic injury biomechanics

“…За даними D.W. Rowed, до введення в клінічну практику рутинного СКТ-обстеження переломи ШВХ при АС несвоєчасно діагностували в 36 % випадків [96]. Це зумовлено незначним травмувальним впливом, відсутністю болю внаслідок терапії кортикостероїдами, а також тим, що переломи тяжко візуалізувати на звичайних рентгенівських знімках [97]. Іноді підозра щодо травматичного ушкодження ШВХ виникає при візуалізації супутнього перелому поперекового відділу [98].…”

“…Так, за даними T. Einsiedel і співавт., її зареєстровано у 97,3 % випадків [93]. У третині випадків перелом ШВХ у пацієнтів з АС закінчується летально [97].…”