C6/7 chalkstick fracture in ankylosing spondylitis with large epidural hematoma
Presentation
Fall off ladder. Reduced lower limb power. Shocked.
Patient Data
Complete ankylosis of the vertebral bodies and facet joint sin keeping with ankylosing spondylitis.
Chalk-stick fracture at the C6/7 level with anterior translation of the superior spinal segment. The fracture line extends through the fused vertebral column, involving the superior endplate of C7, fused disc and posterior inferior endplate of C6. Further extension posteriorly through the fused C6/7 facet joints, lamina and base of the C6 spinous process. Further fractures through the spinous processes of C5 and C4.
Large posterior epidural hematoma extending from the mid C4 level to the mid T7 level, larger on the right side, causing severe canal stenosis and compression of the spinal cord.
Impression
C6/7 chalk-stick fracture in the setting of ankylosing spondylitis.
Large posterior epidural hematoma extending from C4-T7 with cord compression.
MRI advised to assess for cord injury.
Background changes of ankylosing spondylitis.
Chalk-stick fracture at the C6/7 level with minor anterior translation of the superior spinal segment. The fracture line extends through the fused vertebral column, involving the superior endplate of C7, fused disc and posterior inferior endplate of C6. Further extension posteriorly through the fused C6/7 facet joints, lamina and base of the C6 spinous process. Further fractures through the spinous processes of C5 and C4. Abnormal signal within the disc space and fracture site compatible with hemorrhage.
Large posterior epidural hematoma extending from the mid C4 level to the mid T7 level (185 mm in length, 10 mm in depth). The hematoma is slightly larger on the right side where it results in severe narrowing of the spinal canal, anterior displacement and compression of the cord. Almost complete effacement of the spinal subarachnoid space with only minor preservation of CSF signal intensity along the lateral aspects of the cord. Myelopathic cord signal abnormality centrally and on the left at the T5/6 level extending to the T6/7 level. No appreciable cord signal abnormality at the level of the spinal fracture. No cord hemorrhage identified.
No further vertebral fractures demonstrated. Hemorrhage and edematous change in the posterior soft tissues of the neck. No large prevertebral hematoma. Nasogastric tube and endotracheal tube in situ. Ankylosis of the cranio-cervical junction.
Impression
C6/7 chalk-stick fracture in the setting of ankylosing spondylitis.
Large posterior epidural hematoma extending from C4-T7 with cord compression.
Myelopathic cord signal abnormality at the T5/6 level.
No cord hemorrhage evident.
Post posterior stabilsation
C2-T4 posterior stabilization hardware demonstrates normal erect alignment with no evidence of early complication.
Case Discussion
He had a long post operative recovery in ICU with aspiration and respiratory complications, with ongoing lower limb weakness which required extensive rehab.
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