Retrospective Diagnosis of Ankylosing Spondylitis after Spin
Ankylosing spondylitis (AS) is a chronic multisystem inflammatory disorder that primarily affects the axial skeleton of young adults, and if not treated appropriately in the initial stages of the disease, it may lead to diffuse syndesmophyte formation, loss of bone mineral density of vertebral column, and rigid kyphosis. This rigid kyphotic structure exposes the spine to risks of transdiscal fractures and more rarely transcorporeal fractures which are often a result of minor trauma with a high propensity to compress neural structures due to already narrowed spinal canal which often requires surgical management.

This 40-year-old male patient, a software engineer by profession, presented to emergency after severe low back pain immediately after a fall from standing height during walking. The patient admitted that previously he had mild low back pain after prolonged sitting for the last 2 years, but activities of daily life were not hampered. There was a complete neurological deficit ASIA A (Thoracolumbar AO Spine Injury Score 7, A3N4M2) with bladder and bowel involvement. Subsequent radiograph delineated a burst fracture at D10 level (AO type A3) with D9-D10 bridging syndesmophytes with marked decrease of disc spaces along the spinal column. The radiological findings were not very typical of AS. The author performed an HLA-B27 which came out to be positive. The patient was operated on with a complete corpectomy with posterolateral decompression with long-segment fixation (from D8-L2) with interbody cage fixation (3 days after presentation). The patient was started with medication for AS and discharged with mobilization with TLSO brace. Fracture union was evident after 4 months, and the patient was pain-free; the patient was neurologically ASIA B after 11 months. This patient was followed up for 3 years and there was no neurological improvement.