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Dr Darren Lillis
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Mr HS52 yrs oldShopkeeperNormally fit and well
GP referral with neck and upper back pain
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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
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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
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Appendectomy as childNo other relevant history
No medications or allergies
Lives with wife, non smoker, no alcohol
Full time employment
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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
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Tender over the lower cervical and upper thoracic regions- bone and muscular tenderness
Neuro examination was entirely normal
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Soft tissue injuryAnalgesiaPhysioDischarge
Call from radiology- C spine fracture
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1. C Spine fracture- C 6/7 fracture
2. X rays and posture in keeping undiagnosed Ankylosing Spondylitis
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Further investigation
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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
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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)
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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
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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