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NEUROIMAGE
Year : 2013  |  Volume : 61  |  Issue : 3  |  Page : 337

Carrot stick fracture of cervical spine in ankylosing spondylitis


1 Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
2 Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India

Date of Web Publication16-Jul-2013

Correspondence Address:
Lakshmanarao Chittem
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad - 500 082, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.115102

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How to cite this article:
Chittem L, Bhattacharjee S, Harshavardhan K R. Carrot stick fracture of cervical spine in ankylosing spondylitis. Neurol India 2013;61:337

How to cite this URL:
Chittem L, Bhattacharjee S, Harshavardhan K R. Carrot stick fracture of cervical spine in ankylosing spondylitis. Neurol India [serial online] 2013 [cited 2019 Aug 23];61:337. Available from: http://www.neurologyindia.com/text.asp?2013/61/3/337/115102


A 45-year-old male, a known patient of ankylosing spondylitis (AS), suffering from significant restriction of neck and trunk movements for the past 15 years presented with a complain of neck pain for the past 15 days following a trivial trauma. On examination, he could hardly move his neck. Neurological examination was normal. X-ray of cervical spine [Figure 1]a showed completely fused vertebral bodies with C5-C6 subluxation. Magnetic resonance imaging (MRI) confirmed the same with significant compromise in canal diameter [Figure 1]b. Computed tomography (CT) cervical spine [Figure 1]c and d showed ossified anterior longitudinal ligament, calcified inter vertebral disc with fused vertebrae (all three columns) with fracture subluxation at C5-C6 disc level. The ankylosed spine became like a bamboo with increased brittleness so that even a trivial trauma resulted in a horizontal fracture at C5-C6 level involving both anterior and posterior elements [Figure 1]c hence called as carrot-stick fracture. [1] These are highly unstable as the movement of the spine can occur only at the fracture segment requiring surgical immobilization. [2] However, our patient refused surgery. Nonetheless, attention toward this type of imaging in AS is imperative due to the involvement of all three columns that simultaneously require global fusion.
Figure 1: (a) X-ray of cervical spine showing fused cervical vertebrae with fracture at C5-C6 level. (b) MRI of cervical spine showing significant canal compromise. (c) CT of cervical spine showing ossified anterior longitudinal ligament and calcified inter vertebral disc with C5-C6 fracture subluxation. (d) The fracture extending to involve posterior elements as well (arrow)

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  References Top

1.Lindsay JR, Terry RY. Arthritic disorders. In: Lindsay JR, Terry RY, editors. Essentials of Skeletal Radiology. 3 rd ed. Baltimore: Lippincott Williams and Wilkins; 2005. p. 1044.  Back to cited text no. 1
    
2.Kanter AS, Wang MY, Mummaneni PV. A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis. Neurosurg Focus 2008;24:E11.  Back to cited text no. 2
    


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