Ankylosing Spondylitis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathyAnkylosing SpondylitisSCE Rheumatology

A 38-year-old man with long-standing ankylosing spondylitis has extensive syndesmophyte bridging and a bamboo-spine appearance on radiographs. After a low-energy fall, he develops new focal neck pain but has no neurological deficit. Which spinal complication should be presumed until excluded?

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Correct answer: E — Unstable spinal fracture through the fused spine

The correct answer is E. An ankylosed bamboo spine behaves biomechanically like a long bone: long lever arms, ligamentous ossification and frequently reduced bone strength make it vulnerable to unstable, often multicolumn fractures after apparently minor trauma. Cervical injuries are particularly common and may displace secondarily, causing spinal cord injury despite an initially normal neurological examination. New focal spinal pain after trauma therefore warrants urgent spinal precautions and advanced imaging. Cauda equina syndrome is a rare late complication of ankylosing spondylitis rather than the characteristic consequence of a minor fall. Spinal stenosis, spondylolisthesis and cervical disc prolapse do not represent the principal acute hazard created by a fused ankylosed spine.

Reference: Rustagi T, et al. Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes. Journal of Orthopaedic Trauma. 2017;31 Suppl 4:S57-S74. https://pubmed.ncbi.nlm.nih.gov/28816877/