Ankylosing spondylitis complicated by fracture-dislocation

Case contributed by Azza Elgendy
Diagnosis certain


Minor trauma that lead to back pain. The imaging was done 2 weeks after the trauma.

Patient Data

Age: 50 years
Gender: Male

Advanced findings of ankylosing spondylitis manifested by multilevel vertebral body fusion, shiny corner signs, fused facet joints and bilateral sacroiliac joint fusion. Osteoporosis is also noted.

Fracture dislocation is seen at L4/L5. The fracture line involves the L4/L5 disc space anteriorly and involves the pars interarticularis posteriorly. 

Shiny corner sign also known as Romanus sign.

Hyperextension type of fracture that involve L4/L5 ossified and fused disc as well as the anterior syndesmophyte. There is T2 hyperintense signals involving the widened LV4/LV5 disc space most likely represent pseudarthrosis.  Abnormal marrow signal involving the superior and inferior end plates most likely represent bone marrow edema.

Case Discussion

The case is advanced ankylosing spondylitis as manifested by squaring of vertebral bodies , ossifications of the anterior longitidinal ligaments , multiple syndesmophytes causing multiple undulations , shiny corner signs are also seen at multiple levels. There is advanced osteoporosis. Due to the anterior vertebral body fusions as well as the facet joint fusions any minor trauma will lead to fracture. 

There is hyperextension type fracture that involve the fused and ossified disc space. It is also extending into the posterior arch.

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