Presentation
Known case of ankylosing spondylitis with a history of falling from a height, presented to the emergency department with severe neck pain.
Patient Data
Features in keeping with ankylosing spondylitis are demonstrated and characterized by ossification of the spinal ligaments and fusion of the facet joints as well as diffuse skeletal hyperostosis with bridging syndesmophytes and sclerosis of the upper and lower end plates of the examined vertebral bodies.
There is a complete oblique fracture line through the ossified anterior longitudinal ligament at the C6 upper vertebral body that extends posteriorly to the posterior cortex as well as both ankylosed facet joints at this level denoting Chalk stick fracture.
Disrupted alignment of the cervical vertebrae.
Diffuse osteopenic texture.
Features in keeping with ankylosing spondylitis are demonstrated and characterized by ossification of the spinal ligaments and fusion of the facet joints as well as diffuse skeletal hyperostosis with bridging syndesmophytes and sclerosis of the upper and lower end plates of the examined vertebral bodies.
There is a complete oblique fracture line through the ossified anterior longitudinal ligament at the C6 upper vertebral body that extends posteriorly to the posterior cortex as well as both ankylosed facet joints at this level denoting Chalk stick fracture.
There is paravertebral soft tissue edema from C2 to the upper thoracic levels. Focal marrow edema is noted along the fracture lines extending through the facet joints. Vertebral height, disc height, and bone marrow signal are normal. The cord is normal in signal. No evidence of an epidural hematoma. The canal and neural exit foramina are capacious with no high-grade stenosis. Normal flow voids are demonstrated in the vertebral arteries.
Case Discussion
This case demonstrates findings of ankylosing spondylitis which is a high risk for displaced fractures due to increased stress secondary to decreased flexibility after trauma. This injury is known as a "chalk stick" or "carrot stick" fracture. These classically occur in ankylosing spondylitis but can occur in other settings such as DISH +/- OPLL.
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