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General Rehabilitation

Cauda Equina Syndrome After Ground Level Fall With Ankylosing Spondylitis: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 1

    Co-Author(s)

  • Joel Facer, MD

    Resident Physician
    University of Cincinnati Medical Center/College of Medicine PM&R Program
    Cincinnati, Ohio

  • AS

    Allene Swick, MD

    Resident Physician
    University of Cincinnati Medical Center/College of Medicine PM&R Program
    Cincinnati, Ohio

  • Evan Zeldin, MD

    Associate Residency Program Director
    University of Cincinnati
    Cincinnati, Ohio

    • Poster Presenter(s)

  • Katelyn Lotz, DO

    Resident Physician
    University of Cincinnati Medical Center/College of Medicine PM&R Program
    Cincinnati, Ohio

Disclosure(s):
Joel Facer, MD: No financial relationships to disclose
Evan Zeldin, MD: No financial relationships to disclose
Katelyn Lotz, DO: No financial relationships to disclose
Case Diagnosis: 66-year-old male with a BMI of 56 who sustained a ground-level fall resulting in an L2 Chance fracture and subsequent Cauda Equina Syndrome (CES).

Case Description or Program Description: On initial imaging, the patient was found to have an L2 Chance fracture with a rigid spine, consistent with undiagnosed ankylosing spondylitis (AS). The patient experienced significant pain. Upon arrival, he reported left leg paresthesias. The following day, the patient underwent posterior fusion from T11 to L4. Postoperatively, he had no movement in the bilateral lower extremities and persistent extension of the fracture on repeat imaging. Revision surgery was performed to improve fracture alignment, but no motor or sensory recovery occurred.

Setting: Academic Medical Center; inpatient rehabilitation facility (IRF)

Assessment/Results: After stabilizing from complications in the intensive care unit, the patient was transferred to an IRF 35 days after the initial fall. Examination revealed lower motor neuron findings consistent with CES. The patient was discharged home at wheelchair level mobility after completing rehab.

Discussion (relevance): AS alters spinal anatomy and mechanics, increasing the risk of spinal fractures and spinal cord injuries, even from minor trauma, especially in those with increased BMI. Although fractures are more common in the cervical spine, rigid spinal segments make all regions vulnerable. Additionally, AS patients often have impaired mobility, further heightening their fall risk. Early diagnosis of AS is crucial to implementing preventative measures that support bone health and reduce injury risks. Notably, fractures in AS patients are often missed on initial imaging, underscoring the importance of advanced imaging techniques (e.g., CT and MRI) and clinical vigilance in this population.

Conclusions: This case highlights the heightened risk of severe spinal injuries in patients with AS, even from low-impact trauma. It underscores the need for early diagnosis, proactive fall prevention strategies, and comprehensive imaging and evaluation following injury.