Life-threatening spinal cord injury and occult intercostal artery rupture following low-energy trauma in a patient with ankylosing spondylitis: a case report

This case illustrates the heightened and often unrecognized risk of complex, multisystem injuries in AS patients following seemingly minor trauma. Early recognition of hemothorax without rib fractures should raise high suspicion for intercostal artery injury, necessitating a lowered diagnostic threshold for computed tomography angiography. Transcatheter arterial embolization should be considered the first-line treatment for confirmed intercostal artery bleeding rather than a last resort. Prompt diagnosis, individualized multidisciplinary management, and early referral to specialized centers with interventional and spine surgical capabilities are essential for optimizing outcomes in these high-risk patients.