Medical Analysis Report

1. Imaging Findings

Based on the contrast-enhanced CT images provided, the lumbar vertebrae show obvious vertebral shape variations accompanied by the formation of bony bridges (syndesmophytes), consistent with late-stage radiological findings of Ankylosing Spondylitis (AS). A part of the lumbar vertebral body appears locally collapsed, and a clear fracture line can be observed, indicating a lumbar vertebral fracture. The surrounding soft tissue density shows local swelling, but there is no significant large-scale soft tissue hematoma expansion or evidence of nerve root compression. Meanwhile, the adjacent intervertebral disc regions appear disordered, implying deformities of the vertebral segments due to prolonged AS involvement.

2. Possible Diagnoses

1. Ankylosing Spondylitis with Lumbar Fracture: The patient has a known history of AS. Following a low-energy trauma, radiological findings now suggest a local fracture in the lumbar region, aligning with the tendency of patients with this disease to sustain fragility fractures.
2. Osteoporosis-Related Fracture: Osteoporosis is common in elderly women, and limited activity due to AS can further exacerbate loss of bone density. Therefore, an osteoporotic compression or burst fracture should also be considered.
3. Other Pathological Fractures (Rare): For example, fractures caused by tumors or metastatic lesions. However, at present, no typical signs of tumor or bony destruction are seen on imaging, so this remains only a differential diagnosis.

3. Final Diagnosis

Considering the patient’s advanced age, history of AS, the low-energy injury, and the clear lumbar fracture line and ankylosis observed on imaging, the most likely diagnosis is Ankylosing Spondylitis with Lumbar Vertebral Fracture. Currently, there is no evident nerve compression or substantial soft tissue hemorrhage, but close monitoring and follow-up are necessary. MRI may be needed to clarify the status of the spinal cord and nerve roots if clinically indicated.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategies

• Surgical Fixation: Because AS increases spinal rigidity and predisposes to unstable fractures, internal fixation surgery can be considered for unstable or displaced fractures to maintain vertebral stability and prevent secondary injuries and nerve complications.
• Conservative Treatment: For milder, stable fractures or in patients with high surgical risks, options include bracing and bed rest, combined with analgesics and anti-inflammatory medications. Dynamic observation of fracture healing is also necessary.
• Pharmacological Intervention:
  1. Anti-osteoporosis medications: Such as bisphosphonates, vitamin D, and calcium supplements to protect bone mass.
  2. Basic therapy for AS: If the disease is active, NSAIDs can be used, or biological agents (e.g., TNF-α inhibitors) may be considered based on the level of inflammatory activity.
• Pain Management: If needed, use patient-controlled analgesia pumps or oral/topical analgesics, etc.

4.2 Rehabilitation and Exercise Prescription

Rehabilitation training can begin gradually once the fracture is stabilized and firmly fixed surgically, or once conservative treatment has achieved relative stability. A general plan is as follows:

• Early Stage (Postoperative or Acute Phase): Focus on bed-based limb activity and breathing exercises, avoiding excessive weight-bearing or twisting:
  • Frequency: 2-3 times per day
  • Intensity: Mild, without causing evident pain or fatigue
  • Duration: Approximately 10-15 minutes each session
  • Method: Perform ankle pump exercises, isometric quadriceps contractions, gentle active upper body movement on the bed, and deep breathing exercises
• Mid Stage (After Partial Fracture Healing): Gradually increase lumbar and back muscle training and light resistance exercises, under bracing or professional protection:
  • Frequency: 3-4 times per week
  • Intensity: Low to moderate, based on the patient’s tolerance
  • Duration: 20-30 minutes each session, in segments
  • Method: Simple lumbar stabilization exercises near the bed or in a stable environment, such as pelvic bridge exercises (under the guidance of a physician or physical therapist) and lower extremity strength exercises (e.g., straight leg raises)
• Late Stage (After Solid Fracture Healing): Undertake core muscle training and aerobic exercise (e.g., cycling, swimming) under professional guidance to improve overall function and cardiopulmonary endurance:
  • Frequency: 3-5 times per week
  • Intensity: Moderate, with a suitable increase in heart rate without excessive fatigue
  • Duration: 30 minutes or longer, gradually increased
  • Method: Elliptical trainer workouts, water-based floating exercises with minimal impact on the spine, and flexibility exercises such as stretching and joint range-of-motion sessions under professional supervision

Throughout the rehabilitation process, emphasis should be placed on:

• Appropriate use of protective braces or lumbar supports
• A gradual approach, avoiding a sudden increase in exercise intensity
• Vigilant monitoring of symptoms; if pain worsens or new neurological symptoms emerge, seek medical attention promptly

Disclaimer: This report is only a reference analysis based on the existing medical history and radiological materials. It cannot replace in-person consultation or the individualized advice of professional healthcare providers. Patients should follow the guidance of specialized physicians and undergo further examination to confirm their final treatment plan.