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A concurrently occurring spinal cord cross-section and aortic injury after a chalk-stick fracture and dislocation in an ankylosing spondylitis patient: clinical image.

World Neurosurgery 2024 January 25
A 74-year-old female with ankylosing spondylitis presented with back pain, complete paraplegia after a fall. A radiological finding of a bamboo spine, a characteristic feature of ankylosing spondylitis, was observed on computed tomography (CT), along with a fracture-dislocation involving T10 and T11 (chalk-stick fracture), and compression of the descending thoracic aorta due to the caudal bony column. The patient underwent an open reduction and T8-L3 posterior fusion in the operating room. A complete cross-section of the spinal cord was observed during surgery. Post-operation, a decrease in blood pressure led to a thoracotomy and thoracic endovascular aortic repair due to a crack in the descending aorta wall. Thoracolumbar fracture-dislocations, particularly in patients with AS, are characterized by instability and can be further complicated by concurrent vascular and spinal cord injuries. It is crucial therefore to recognize the potential for vascular and spinal cord injuries early on in such cases.

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