Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis.
Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine fractures. Long-standing pain may mask the symptoms of the fracture. Radiological imaging of the cervical spine may fail to identify the fracture due to the distorted anatomy, ossified ligaments and artefacts leading to delay in diagnosis and increased risk of neurological complications. The objectives are to identify the incidence and risk factors for delay in presentation of cervical spine fractures in patients with AS. Retrospective case series study of all patients with AS and cervical spine fracture admitted over a 12-year period at Queen Elizabeth National Spinal Injuries Unit, Scotland. Results show that total of 32 patients reviewed with AS and cervical spine fractures. In 19 patients (59.4%), a fracture was not identified on plain radiographs. Only five patients (15.6%) presented immediately after the injury. Of the 15 patients (46.9%) who were initially neurologically intact, three patients had neurological deterioration before admission. Cervical spine fractures in patients with long-standing AS are common and usually under evaluated. Early diagnosis with appropriate radiological investigations may prevent the possible long-term neurological cord damage.
Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK. fanwar@nhs.net
Fahim
F
Anwar
A
A
Al-Khayer
G
G
Joseph
M H
MH
Fraser
M V
MV
Jigajinni
D B
DB
Allan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D002908:Chronic Disease; D015897:Comorbidity; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000453:epidemiology