Occult Seat-belt-type Transverse Fracture of the L4 Vertebra in Ankylosing Spondylitis: Case report and review of the literature

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Case presentation: A 78 year-old woman with ankylosing spondylitis experienced unusual intractable pain around her left hip joint after a very minor fall two weeks before admission. A thorough skeletal survey found nothing remarkable except findings of ankylosing spondylitis, but an occult seat-belt-type fracture of the L4 vertebra led to serious dislocation of the L4 with Frankel A paralysis. Eemergency surgery including posterior reduction and decompression followed by anterior fusion was successful for the patient to regain a Frankel E ambulatory neurological status.