What’s the diagnosis? #11

The underlying diagnosis is ankylosing spondylitis. The c-spine x-ray shows  the bamboo spine appearance pretty well.

If someone has ankylosing spondlylitis then they’re incredibly high risk for spinal fractures in the context of even minor trauma like this.

Outcome

The inadequate nature of the plain film was recognised (I can only see to C6) and a CT was obtained.

Hopefully that’s a fairly obvious fracure to most of us.

I’ve seen a few of these c-spine fractures in people with bamboo spines and they seem to do fairly poorly. The other thing is to be careful with immobilisation. If your neck is normally in a hyperflexed position then ramming it back into a neutral position with a collar seems a terrible idea. I tend to immobilise these guys in position of comfort – be that partially sitting up with a folded sheet to support the head and allow immobilisation with blocks or collar.