Purpose <p>Thoracolumbar (TL) extension-distraction injuries (EDI) are unstable injuries. Patients with ankylosing spinal disorders, such as diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS), are particularly susceptible, even with minimal trauma during routine inpatient care such as bed to table transfers for imaging studies.</p> Methods <p>This work represents a retrospective case series. The neurosurgery department internal patient database was queried for TL EDI. Patient history data was reviewed to identify patients that suffered TL EDI while receiving inpatient hospital care with ankylosing spinal disorders. Data from the hospital courses of the identified patients was extracted for analysis. All data was obtained through electronic health record review.</p> Results <p>3 patients were included. All had no evidence of spinal column injury at admission. Two injuries occurred during transfer to a CT table, while the third occurred during transfers for imaging or during cardiopulmonary resuscitation. All patients were neurologically intact after injury and underwent surgical stabilization. Two patients had favorable neurologic outcomes at one year; one died shortly after discharge due to unrelated medical issues.</p> Conclusions <p>Patients with ankylosing spinal disorders may have an increased risk of iatrogenic TL EDI during routine hospital care, despite adherence to standard safety protocols. Awareness of this risk is critical. Extra precautions during patient transfers and repositioning, along with multidisciplinary coordination, are essential to prevent these devastating injuries.</p> Graphical abstract <p></p>