Clinical images: Epidural hematoma in ankylosing spondylitis



Illustration 1.

The cervical spine in patients who have longstanding ankylosing spondylitis (AS) is so biomechanically fragile that even minor trauma can cause fractures and serious neurologic lesions. The patient, a 63-year-old man with a 25-year history of AS, experienced a minor fall, resulting in paraplegia. Computed tomography (CT) with sagittal reconstruction revealed bamboo spine with a C7 spinous process fracture (A) (arrow), and 3-dimensional CT showed anterior-to-posterior horizontal fracture at C7–T1 (B) (arrow). Fat-suppressed magnetic resonance imaging (MRI) confirmed the presence of a large posterior epidural hematoma with cord compression extending from C3 to T2 (C) (arrowheads). Although surgical decompression was prompt, the patient died. Evaluation using MRI is essential in patients with AS who have neurologic symptoms after injury of the spinal cord, when an epidural hematoma is suspected. A good outcome depends on prompt diagnosis and surgery.