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AS Spinal Fracture — SCE Rheumatology MCQ

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HardRheumatology EmergenciesAS Spinal FractureSCE Rheumatology

A patient with ankylosing spondylitis develops severe spinal pain after a minor fall, but plain radiographs show no fracture. What is the most appropriate next investigation?

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Correct answer: E — Urgent CT of the spine, with MRI when neurological or ligamentous injury is suspected, after safety review, with clinical reassessment

The best answer is “Urgent CT of the spine, with MRI when neurological or ligamentous injury is suspected, after safety review, with clinical reassessment”. Ankylosed spines fracture after relatively minor trauma and injuries may be occult on radiographs; urgent cross-sectional imaging is required, with CT defining fracture and MRI assessing neural or soft-tissue injury. The remaining choices—“Repeat plain radiographs after two weeks, after specialist assessment, with clinical reassessment, within a rheumatology pathway, within a rheumatology pathway”, “Radionuclide bone scanning as the initial test, with clinical reassessment, within a rheumatology pathway, with clinical reassessment, after safety review”, “DXA of the lumbar spine, within a rheumatology pathway, after safety review, after specialist assessment, within a rheumatology pathway”, “Elective musculoskeletal ultrasound, after specialist assessment, after safety review, after specialist assessment, with clinical reassessment, after safety review, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG65 spondyloarthritis: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations