Bamboo Spine in Ankylosing Spondylitis is at Increased Risk of Fracture

Abstract

We present a case of missed spinal injury in a patient with ankylosing spondylitis that led to severe consequences for the patient. We present a radiograph showing a classic appearance of “bamboo spine”, and subsequent MRI showing a three-column fracture. Bamboo spine occurs when the intervertebral discs ossify; this decreases flexibility and significantly increases the likelihood of spinal fracture with low energy mechanisms of injury. The mechanism of injury in this case was a fall from standing height which ultimately resulted in a severe spinal fracture with paraplegia. The absence of a fracture on radiographs in patients that have ankylosing spondylitis does not eliminate the presence of a fracture, and CT and MRI may well be indicated to confirm that there is no bony injury. We would like to highlight the importance of maintaining a high index of suspicion for patients who cannot give complete histories. The radiological appearance of bamboo spine should sharpen the clinical judgement of all who encounter it.