Posttraumatic C5 Palsy After Application of Hard Collar in Ankylosing Spondylitis

Abstract

Background: Ankylosing spondylitis (AS) is a systemic enthesopathy. In its presence, spinal fractures are often unstable. Acknowledging the preinjury level of kyphosis is key in the management of cervical fractures, and placement into a hard collar has been shown to result in life-threatening spinal cord complications.

Case description: This report presents the unique case of a patient with AS who developed a unilateral C5 palsy after the application of a hard collar for a C5/6 fracture, to our knowledge the first such case presented to date. The patient subsequently went on to an anterior fixation and partially recovered from the C5 palsy/injury. After the case report is an examination of the currently available literature and evidence exploring the factors that may contribute to C5 palsy after the application of a collar for acute fracture in AS.

Conclusions: We described the first case in the literature of a posttraumatic C5 palsy after application of a hard collar in AS. This report and literature review should act to underscore the importance of respecting a preexisting rigid kyphotic deformity in cervical fractures but also to stimulate further thoughts and investigations into what may contribute to a posttraumatic C5 palsy.

Keywords: Ankylosing spondylitis; C5 palsy; Cervical fracture; Cervical orthosis.