Background: Patients with ankylosing spondylitis (AS) are especially prone to sustaining spinal fractures. A 72-year-old male with AS had a previous T10/11 chalkstick fracture requiring a T8-L1 fusion 1 year ago. He subsequently presented with a newly diagnosed acute chalkstick fracture of L1 which was treated without surgery. Case Description: A 72-year-old male with AS and a T10/11 chalkstick fracture had undergone a T8-L1 thoracolumbar fusion 1 year ago. He newly presented after a fall from his bed with a new acute L1 chalkstick fracture that was successfully managed nonsurgically. Conclusion: Patients with AS are at high risk for spinal fractures. Here, elderly male, following an original T10/11 chalkstick fracture and a T8-L1 fusion 1 year ago, presented with a new acute L1 chalkstick fracture managed without surgery.

Dear Editor, "Tui Na" (推拿) or traditional chinese medicine (TCM) massage is an alternative medicine therapy practised in many Chinese communities for the management of musculoskeletal ailments. During the massage, TCM practitioners utilise their fingers, hands, elbows, knees and/or feet to exert mechanical force on the patient's body to stimulate acupuncture points. This process is believed to restore the flow of the vital energy 'qi' throughout the meridians of the body, thereby enabling healing. 1 While non-invasive and relatively harmless, the force applied during Tui Na has been known to cause complications of epidural haematoma, 2 cerebral vascular accident 3 and prolapsed intervertebral discs. 4 In rare cases, vertebral fractures have also been reported. Here we report a local case of cervical vertebral fracture in an elderly lady after Tui Na massage, which was subsequently treated by surgical intervention involving anterior cervical corpectomy and posterior instrumentation.A 73-year-old woman presented to our accident and emergency department with a 3-day history of neck pain and stiffness following a neck "cracking" Tui Na. This was preceded by a history of occasional mild axial neck pain for 2 years without any radicular nor myelopathic symptoms. There were no previously diagnosed cervical disorders in this patient. The massage was conducted by a TCM practitioner near her temple using only his hands. During the massage, the patient underwent forceful manipulation and compressive pressure applied on her neck in multiple directions. She did not note a particular manoeuvre that triggered the pain. After the massage, she experienced progressively worsening severe neck pain and stiffness and decided to seek medical treatment. She did not report any radiation of pain, limb weakness or numbness, urinary retention or bowel incontinence. There was no other reported fall or further trauma to the neck. The patient was not known to have any other medical conditions and was not on any long-term medications. She was also not taking any traditional medications nor supplements. Functionally, she was independent in all her activities of daily living and was community ambulant without aid prior to her TCM treatment