Translate this page into:
Notice: Please configure GTranslate from WP-Admin -> Settings -> GTranslate to see it in action.
Acute L1 chalkstick fracture post fall in a patient with known ankylosing spondylitis and previous instrumentation and fusion of T8-L1
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Choy YB, Chan DN, Chen HB, Yilun H. Acute L1 chalkstick fracture post fall in a patient with known ankylosing spondylitis and previous instrumentation and fusion of T8-L1. Surg Neurol Int 2021;12:589.
Patients with ankylosing spondylitis (AS) are especially prone to sustaining spinal fractures. A 72-year-old male with AS had a previous T10/11 chalkstick fracture requiring a T8-L1 fusion 1 year ago. He subsequently presented with a newly diagnosed acute chalkstick fracture of L1 which was treated without surgery.
A 72-year-old male with AS and a T10/11 chalkstick fracture had undergone a T8-L1 thoracolumbar fusion 1 year ago. He newly presented after a fall from his bed with a new acute L1 chalkstick fracture that was successfully managed nonsurgically.
Patients with AS are at high risk for spinal fractures. Here, elderly male, following an original T10/11 chalkstick fracture and a T8-L1 fusion 1 year ago, presented with a new acute L1 chalkstick fracture managed without surgery.
Lower back pain
Spinal instrumentation and fusion
Ankylosing spondylitis (AS) is one of the spondyloarthropathies. These patients may develop structurally unstable chalkstick (or carrot stick) fractures (i.e., fractures occurring in a brittle spine), which is a poor prognostic finding. Here, we present a 72-year-old male who, 1 year following a T10/11 chalkstick fracture and T8-L1 fusion, developed a new L1 fracture successfully managed without repeated surgical intervention.
A 72-year-old male with a complex medical history [Table 1], including AS, presented 1 year ago with a T10-T11 chalkstick fracture requiring a T8-L1 fusion. He then presented subsequently with another fall with increased low back pain, but without any other neurological deficit, and a new L1 chalkstick fracture.
Lumbar X-rays showed AS, a loss of height of T10 vertebral body, and new T12-L1 anterior syndesmophyte disruption [Figures 1 and 2]. The thoracic CT showed an acute chalkstick fracture of L1 extending posteriorly to the left L1 pedicle adjacent to the transpedicular screw and extending through to the calcified posterior interspinous ligament [Figure 3]. The previous T8-L1 posterior transpedicular screws fixation demonstrated no new pathology and/or periprosthetic loosening.
As the patient had no new neurological deficit, he was managed nonsurgically; rather, analgesia was optimized. Notably, due to his severe dementia, he was unable to tolerate a thoracic lumbar sacral orthosis. One month later, the patient’s neurological examination and X-rays remained unchanged [Figures 4 and 5].
As patients living with AS are up to 4 times more likely to sustain spinal fractures, they should undergo definitive diagnostic radiographic studies early in their clinical courses to determine appropriate treatment. Here, a 72-year-old male presented with a second L1 chalkstick fracture 1 year following the previous T10/11 chalkstick fracture and T8/ L1 fusion. This time, without any neurological deficits, it was elected to treat him nonsurgically. Notably, a systematic review involving 76 Medline and EMBASE articles (345 AS patients) revealed no significant differences in mortality rates <3 months after presentation with AS-related chalkstick fractures (4.9% with surgery vs. 7.3% without surgery).
Patients with AS have an increased susceptibility to spinal fractures. Here, a 72-year-old male, 1 year following a T10/11 chalkstick fracture warranting a T8-L1 fusion, presented with a new L1 chalkstick fracture that was successfully managed nonsurgically.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.