Summary
A 41-year-old male with a 20-year history of classical ankylosing spondylitis, psoriasis and seropositive, nodular erosive rheumatoid arthritis presented with a 12-month history of thoracolumbar junction pain following minor trauma. A pseudoarthrosis was noted at the T11/12 level on plain radiographs and tomograms. A gallium scan showed no increased isotope uptake, and a computed tomogram (CT) revealed no evidence of a paraspinal collection. Conservative management including cast immobilisation and local radiotherapy was ineffective, and spinal fusion was required. A typical Andersson lesion was found at operation. The diagnostic and therapeutic problems of such discovertebral lesions are discussed.
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References
Dihlmann, W., Gelling, G. Disco-vertebral destructive lesions (so-called Andersson lesions) associated with ankylosing spondylitis. Skeletal Radiol 1978, 3, 10–16.
Frank, P., Gleeson, J.A. Destructive vertebral lesions in ankylosing spondylitis. Br J Radiol 1975, 48, 755–58.
Cawley, M.I.D., Chalmers, T.M., Kellegren, J.H., Ball, J. Destructive lesions of the vertebral bodies in ankylosing spondylitis. Ann Rheum Dis 1972, 31, 345–358.
Resnik, D., Niwayama, G. Diagnosis of bone and joint disorders. Vol. 2. Saunders, Philadelphia pp. 978–982.
Wise, E.M., Irby, W.R. Spondylodiscitis in ankylosing spondylitis: Variable presentation. J Rheumatol 1983, 10, 1004–1006.
Little, H., Urowitz, M.B., Smythe, H.A., Rosen, P.S. Asymptomatic spondyoldiscitis. An unusual feature of ankylosing spondylitis. Arthritis Rheum 1974, 14, 487–493.
Rosen, P.S., Graham, D.C. Ankylosing spondylitis. A clinical review of 128 cases. Arch Inter-Amer Rheum 1962, 5, 158–233.
Dunn, N.A. Spinal complications of ankylosing spondylitis. J Roy Soc Med 1986, 79, 184.
Kanefield, D.G., Mullins, B.P., Freehafer, A.A., Furley, J.G., Horenstein, S., Chamberlain, W.B. Destructive lesions of the spine in rheumatoid ankylosing spondylitis. J Bone Joint Surg (Am) 1969, 51-A, 1369–1375.
Yau, A.M.C., Chan, R.N.W. Stress fractures of the fused lumbodorsal spine in ankylosing spondylitis: a review of three cases. J Bone Joint Surg 1974, 56-B, 681–687.
Kang, D., Leong, J.C.Y., Ho, E.K.W., Chan, F.L., Chow, S.P. Spinal pseudoarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion. J Bone Joint Surg 1988, 70-B, 443–447.
McEwen, C., Di Tata, D., Lingg, C., Porini, A., Good, A., Rankin, T. Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. Arthritis Rheum 1971, 14, 291–318.
Hanley, J.G., Russel, M.L., Gladman, D.L. Psoriatic spondyloarthropathy: a long-term study. Ann Rheum Dis 1988, 47, 386–393.
Darby, S.C., Doll, R., Gill, S.K., Smith, P.G. Long-term mortality after a single course of X-rays in patients treated for ankylosing spondylitis. Br J Cancer 1987, 55, 179–190.
Alarcon-Segovia, D., Martinez-Cordero, E. Ankylosing spondylitis and rheumatoid arthritis in a patient with Paget's disease. Arch Intern Med 1985, 145, 1915–1917.
Alexander, E.L., Bias, W.B., Arnett, F.C. The coexistence of rheumatoid arthritis with Reiter's syndrome and/or ankylosing spondylitis: a model of dual HLA-associated disease susceptibility and expression. J Rheumatol 1981, 8, 398–404.
Luthra, H.S., Ferguson, R.H., Conn, D.L. Co-existence of ankylosing spondylitis in rheumatoid arthritis. Arthritis Rheum 1976, 19, 111–114.
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Arnold, M.H., Brooks, P.M., Ryan, M. et al. A destructive discovertebral lesion: Septic discitis, ankylosing spondylitis, or rheumatoid arthritis ?. Clin Rheumatol 8, 277–281 (1989). https://doi.org/10.1007/BF02030087
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DOI: https://doi.org/10.1007/BF02030087