Dr Darren Lillis

Mr HS52 yrs oldShopkeeperNormally fit and well

GP referral with neck and upper back pain

Fell on the ice 4 weeks previouslyStepping down off a foot bridge, his

two feet went out from under himLanded on his sacrumFelt a “shudder” transmitted from

his sacrum to his neck on impact

No loss of power or sensation in limbs Got himself off the ground, walked

home. Went to work over the following 2

weeks

Ongoing lower cervical and upper thoracic pain Went to his GP Emergency Dept

Appendectomy as childNo other relevant history

No medications or allergies

Lives with wife, non smoker, no alcohol

Full time employment

Kyphotic posture Fixed flexion deformity in his C spine Chin- chest distance= 5cm Unable to flex his neck laterally Only able to rotate approx 10 degrees

R+L

Stated this was normal for him- no recent change associated with the fall

Tender over the lower cervical and upper thoracic regions- bone and muscular tenderness

Neuro examination was entirely normal

Soft tissue injuryAnalgesiaPhysioDischarge

Call from radiology- C spine fracture

1. C Spine fracture- C 6/7 fracture

2. X rays and posture in keeping undiagnosed Ankylosing Spondylitis

Further investigation

No Miami J Cervical collarNo spinal precautionsTransferred to the Mater Spinal Unit

once a bed became available

Reviewed by Rheumatology- Likely Ank Spond but inflammatory markers normal... burnt out

Inflammatory arthropathy Ligaments and discs become calicified-

characteristic flexed posture, loss of flexibility

Incidence of spinal fractures is 4 times that of the normal population (1)

75% of these occur in the lower C Spine region (2)

Multi level fractures associated with minor trauma (3)

1. Amamilo SC (1989) Fractures of the cervical spine in patients with

ankylosing spondylitis. Orthop Rev 18:339–3442. Hunter T, Dubo HIC (1983) Spinal

fractures complicating ankylosing spondylitis. A long-term follow up study. Arthritis Rheum 26:751–759

3. J. Mountney, A. J. Murphy, J. L. Fowler Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis. Eur Spine J (2005) 14: 689–693

C7 on T1, Peg and clear AP C Spine views should be attained

Further images should be attained using arm pull, swimmers views or CT