Use of stand-up magnetic resonance imaging for evaluation of a cervicothoracic injury in a patient with ankylosing spondylitis

BACKGROUND CONTEXT: Injuries at the cervicothoracic junction are common in patients with ankylosing spondylitis. These injuries present challenges for both initial and follow-up imagings. PURPOSE: To describe a case of a patient with ankylosing spondylitis who was treated with laminectomy and a cervicothoracic orthosis for a spinal epidural hematoma after a nondisplaced fracture at the cervicothoracic junction and to discuss the merits of stand-up magnetic resonance imaging (MRI) for follow-up evaluation of this type of injury. STUDY DESIGN/SETTING: Case report. METHODS: Clinical data of a patient with ankylosing spondylitis who sustained a nondisplaced C7 fracture are presented, followed by a detailed review of the literature concerning imaging techniques available for the evaluation of cervical spine trauma in this patient population. RESULTS: The patient was treated with emergent laminectomy and evacuation of the epidural hematoma, followed by definitive management in a cervicothoracic orthosis secondary to medical comorbidities. The patient was then successfully followed postoperatively with stand-up MRI because conventional imaging techniques could not adequately image the injury level in an upright position. CONCLUSIONS: Cervicothoracic injuries are common in patients with ankylosing spondylitis and may be difficult to follow with conventional imaging techniques. Stand-up MRI is a relatively new modality that may offer significant advantages over conventional imaging because of the ability to evaluate the cervicothoracic junction in a more functional position and the lack of a confining space such as that found in standard MRI units.