A Near Miss: Cervical Spine Fracture in a Young Adult

Case Report

J Fam Med. 2016; 3(9): 1090.

A Near Miss: Cervical Spine Fracture in a Young Adult

Chiu W-Y¹*, Su T-H¹ and Lo Y-H²

¹Departments of Family Medicine, Kaohsiung Armed Forces General Hospital, Republic of China

²Department of Family Medicine, Zouying Branch of Kaohsiung Armed Forces General Hospital, Republic of China

*Corresponding author: Wen-Yi Chiu, Departments of Family Medicine, Kaohsiung Armed Forces General Hospital, Zhong Zheng 1st Rd, Lingya Dist, Kaohsiung City, Taiwan, Republic of China

Received: September 27, 2016; Accepted: October 17, 2016; Published: October 20, 2016


Ankylosing spondylitis changes the biomechanical properties of the axial spine due to chronic inflammation. The patient might underwent spine fracture and following neurologic sequelae even just low-energy damage. Here we present a young adult with unrevealed ankylosing spondylitis diagnosed with cervical fracture after minimal trauma. Prompt imaging studies establish the diagnosis and subsequently surgical treatment was performed. The postoperative recovery was uneventful.

Keywords: Ankylosing spondylitis; Cervical fracture; Trauma; Computed tomography


Ankylosing spondylitis (AS) (also known as Bechterew's disease and Marie Strümpell disease) is a chronic inflammatory disease of unknown cause that primarily affects the axial skeleton. Spinal fractures are up to four times more common in patients with ankylosing spondylitis than the general population, with a lifetime incidence ranging from 5% to 15%. Cervical spine is the most frequent site for acute spinal fractures in AS but was easily delayed or miss diagnosed.

Case Presentation

A 31-year-old young man presented to our clinic with a twoweek history of neck pain after a fall injury. The familial and personal history of the patient wasn’t significant. On examination, he appeared relatively weak. His vital signs were as follows: blood pressure of 124/78mm Hg, heart rate of 78 beats per minute and respiratory rate of 16 breaths per minute. He was a febrile. The neurologic examination revealed marked weaker upper limbs on the right proximally (3/5) and distally (3/5) than the left (3/5 and 3/5). Resting tremor was noticed.Pain and temperature sensation was present and fine touch was intact over shoulders and upper limbs. The neck movement was smooth.

Due to poor response to ketorolac injection, cervical spine X ray was arranged. Plain radiographs incidentally showed ankylosis of the cervical spine and spondylolisthesis of C5 on C6 (Figure 1A). By further magnetic resonance imaging (MRI) of cervical spine, fracture of C6 body and spinal process and mild the cal sac compression of C6 level was disclosed (Figure 1B). Thereafter he was admitted to the trauma service and subsequently underwent C6 corpectomy and titanium mesh cage with anterior cervical plate of C5, C6 and C7 by the neurosurgical service. The human leukocyte antigen B27(HLA-B27) test was positiveeventually. After that the post-operative recovery was uneventful.The Computed Tomography (CT) of cervical spine showed intact alignment with internal instrument fixation over C5-7 with cage fusion at one-month follow-up (Figure 2). The patient was seen in outpatient regular follow-up in half a year and his muscle power gradually recovered after rehabilitation program except mild limitation of neck rotation.

Citation:Chiu W-Y, Su T-H and Lo Y-H. A Near Miss: Cervical Spine Fracture in a Young Adult. J Fam Med. 2016; 3(9): 1090. ISSN: 2380-0658