Presentation
Blunt trauma
Patient Data
Patient with known ankylosing spondylitis resulting in extensive bridging syndesmophytes and facet ankylosis of the cervical and visualized thoracic spine.
There is a transverse fracture through the superior aspect of the C4 vertebral body. The fracture is parallel to and extends through the superior vertebral end plate and also through the posterior elements with involvement of the left lamina of C4 and C5 and the distal tip of the C3 spinous process. There is also a fracture of ossified right ligamentum flavum at the level of C3-C4, which is minimally displaced into the spinal canal, with also extension to the base of the C4 spinous process. Associated mild central canal stenosis is noted. There is minimal anterior widening of the fracture through the C4 vertebral body. No traumatic spondylolisthesis.
These key images demonstrate the described findings above.
Case Discussion
Patients with ankylosing spondylitis are prone to unstable fractures involving the anterior, middle and posterior columns, often referred to as chalk stick fracture. Fractures occur following even minor trauma so one should have a low threshold for obtaining a CT scan for these patients as delays in diagnosis can lead to neurological deterioration and morbidity.
Case co-author: Rehana Jaffer, MD, FRCPC
Unable to process the form. Check for errors and try again.