Question
A 62 year old man with long standing ankylosing spondylitis falls from standing height and has new neck pain. Plain radiographs are reported as normal.
- Why is this patient at high risk?
- How would you investigate and manage him?
- What are the complications?
Answer
Why the risk is high
- The fused, osteoporotic spine behaves like a long bone, so minor trauma can cause unstable fractures through all three columns
- Fractures often occur at the cervicothoracic junction and are easily missed on radiographs
- Preexisting kyphosis makes positioning and imaging difficult
Investigation and management
- Treat as an unstable fracture until proven otherwise
- CT of the whole spine, and MRI for occult fractures, epidural haematoma and cord injury
- Immobilise in the patient’s preexisting posture, never forcing the neck into a neutral position
- Long segment posterior instrumented fusion, with at least three levels above and below
- Halo vest is poorly tolerated and has a high complication rate
Complications
- Epidural haematoma causing delayed neurological deterioration
- Neurological injury, often complete
- High mortality from respiratory and medical complications in older patients
- Nonunion and pseudarthrosis (Andersson lesion)
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.