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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
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