What's the Diagnosis - Case 15

History 61 year old man with recent fall in the shower.

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Findings The first lateral radiograph demonstrates marked ossification of the cervical spine with bony bridging across the disc spaces and of the lateral masses. The second lateral radiograph and subsequent cross sectional images demonstrate a fracture through the level of the disc space that propagates to involve the posterior elements of the spine. MRI demonstrates edema and hematoma adjacent to the site of the fracture.

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Diagnosis: Ankylosing Spondylitis with insufficiency fracture Ankylosing spondylitis has been previously described in an aforementioned case and again represents one of the seronegative arthropathies which causes prominent bone production within the axial skeleton or at the entheses. Although prominent bone is present, it is more predisposed to fracture secondary to rigidity, and fractures often will occur with minor trauma. Pseudoarthrosis in ankylosing spondylitis is another common complication thought to represent sequelae of localized inflammatory process centered at the disc space or of previously undiagnosed minor trauma.

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Follow Up: Subsequent Posterior fusion and decompression with marked improvement in alignment.

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Resources •

http://www.emedicine.com/RADIO/topic41.htm#section~Radiograph

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http://pubs.rsna.org/doi/full/10.1148/rg.253045117

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