• Aadhar Sharma, Reza Mobasheri, and Salvatore Russo.
• Spinal Trauma Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, England. Electronic address: aadhar.sharma@nhs.net.
• World Neurosurg. 2019 Nov 1; 131: 27-31.

BackgroundAnkylosing 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 DescriptionThis 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.ConclusionsWe 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.Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.

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