Yagi Mitsuru, Sato Shunsuke, Miyake Atsushi, Asazuma Takashi
Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Japan.
Case Rep Orthop. 2015;2015:590935. doi: 10.1155/2015/590935. Epub 2015 Sep 8.
The aim of this study is to report the rare occurrence of simultaneous double spine fractures in a patient with progressive ankylosing spondylitis (AS). An 82-year-old male with established AS had low-energy falls. He had sustained simultaneous double spine fractures and died. Plain radiographs of the cervical spine were unremarkable in detecting a cervical spine fracture in a patient with AS and a spinal cord injury following a fall. CT scan showed a displaced fracture at the C6/C7 with American Spinal Injury Association-A spinal cord injury and displaced fracture at L1. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fracture and dislocation that were facilitated by spinal rigidity from AS. This case report illustrates the importance of obtaining a detailed medical history and thorough imaging study when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of entire spine CT scan in the evaluation of the mechanism, further spine fractures, and manner of death. Despite the occurrence of spine fracture in AS patients, simultaneous double or multiple spine fractures are extremely rare and can be missed. Care should be taken for the further spine fracture in the entire spine in patient with AS.
本研究的目的是报告一名患有强直性脊柱炎（AS）的患者罕见地同时发生双椎体骨折的情况。一名82岁患有确诊AS的男性发生了低能量跌倒。他同时发生了双椎体骨折并死亡。对于一名AS患者跌倒后发生颈椎骨折和脊髓损伤的情况，颈椎X线平片在检测颈椎骨折方面并无明显异常。CT扫描显示C6/C7处有移位骨折，美国脊髓损伤协会（ASIA）分级为A级脊髓损伤，L1处也有移位骨折。死亡原因被确定为由颈椎骨折和脱位导致的上位脊髓损伤，而AS导致的脊柱僵硬促使了这种情况的发生。本病例报告说明了在调查死亡原因时，包括像AS这样的非致命疾病，获取详细病史和进行全面影像学检查的重要性。此外，它还展示了全脊柱CT扫描在评估损伤机制、进一步的脊柱骨折和死亡方式方面的价值。尽管AS患者会发生脊柱骨折，但同时发生双椎体或多椎体骨折极为罕见，且可能被漏诊。对于AS患者，应关注其整个脊柱是否会发生进一步的骨折。
