Spine: fracture in ankylosing spondylitis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: fracture in ankylosing spondylitis

Sample item

A 55-year-old man with long-standing ankylosing spondylitis and a fixed kyphosis falls from standing height and has severe neck pain. Plain radiographs look unremarkable. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. CT of the cervical spine with immobilisation

The fused, brittle spine behaves like a long bone and fractures after trivial injury, often through the lower cervical spine. These injuries are easily missed on plain films and are unstable with a high risk of cord damage. The spine should be kept immobilised and imaged with CT, with MRI if neurology is present.

Option by option

  • A. Reassurance and a soft collar

    A soft collar with reassurance would risk missing an unstable fracture.

  • B. Flexion-extension radiographs

    Dynamic films in a patient with a possible unstable fracture could cause cord injury.

  • C. Start physiotherapy for neck mobility

    Physiotherapy before excluding fracture is unsafe.

  • D. CT of the cervical spine with immobilisation (correct)

    Correct. A rigid spine fractures with trivial trauma and needs immobilisation and CT.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, CT of the cervical spine with immobilisation. The fused, brittle spine behaves like a long bone and fractures after trivial injury, often through the lower cervical spine.

Why is "Reassurance and a soft collar" not the answer?

A soft collar with reassurance would risk missing an unstable fracture.

Why is "Flexion-extension radiographs" not the answer?

Dynamic films in a patient with a possible unstable fracture could cause cord injury.

Why is "Start physiotherapy for neck mobility" not the answer?

Physiotherapy before excluding fracture is unsafe.

What concept does this question test?

It tests Spine: fracture in ankylosing spondylitis in Orthopaedics. These injuries are easily missed on plain films and are unstable with a high risk of cord damage. The spine should be kept immobilised and imaged with CT, with MRI if neurology is present.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: fracture in ankylosing spondylitis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.