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Positioning for plain spinal radiography producing paraplegia in a patient with ankylosing spondylitis

Duchess of Kent Children's Hospital and University of Hong Kong, 12 Sandy Bay Road, Hong Kong ^* Department of Orthopaedic Surgery, University of Hong Kong, Hong Kong

This excerpt was created in the absence of an abstract.

In the later stages of ankylosing spondylitis the spine is prone to fracture even with minor trauma (Resnick & Niwayama, 1988), because it is rigid, deformed and osteoporotic. Following a trivial injury the patient usually complains of mild back pain. The radiographic findings may not be helpful as the quality of radiographs is often poor owing to severe osteoporosis. A misdiagnosis is not uncommon, nor is the development of neurological symptoms due to displacement of previous fractures. As far as we know, no case has been reported where the patient becomes paraplegic while being positioned for plain radiographs of the spine. We report such a case.

A female aged 75 years with a history of ankylosing spondylitis for over 40 years consulted a local "bonesetter" for back pain a few days after a minor incident when she twisted her back at home. While positioning her for plain radiographs of the spine a crack was heard and she developed weakness in both lower limbs, and was unable to walk. She also became incontinent of urine.

Three months later the patient was referred to the Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong. Clinical examination revealed a localized tenderness over the midlumbar area of her kypho-scoliotic spine. She had impaired sensation in both lower limbs. The motor power was MRC grade 0 for hip and knee muscles, and grade 1 for ankle and foot muscles. Knee and ankle tendon reflexes were absent.

Key Words: Ankylosing spondylitis • Pseudarthrosis • Paraplegia • Neurological recovery

Received for publication April 1, 1990. Revision received January 1, 1991.