A 50-year-old man with long-standing ankylosing spondylitis sustains minor trauma and develops severe neck pain. Imaging reveals a fracture extending through all three columns of the cervical spine. The most appropriate initial management is:

• A Surgical stabilization ✓
• B Hard collar immobilization for 6 weeks
• C Halo vest immobilization
• D Bed rest and analgesics

Explanation

In ankylosing spondylitis, the spine is rigid and brittle, and fractures (often through the disco-vertebral junction or lower cervical spine) are typically unstable three-column injuries even after minor trauma. These fractures have a high rate of neurologic deterioration and nonunion with conservative management. Surgical stabilization is the treatment of choice. Collar or halo immobilization alone is insufficient for these unstable injuries.

Reference: Browner: Skeletal Trauma, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.