Background Spondylodiscitis (SD) that might occur in the vertebral bodies and intervertebral discs of patients with ankylosing spondylitis (AS) also referred as the Andersson lesion. These discovertebral lesions may result from inflammation or stress fractures of the complete ankylosed spine. The exact prevalence of SD complicating AS is unknown. and our knowledge about the clinical presentation an course of this entity is limited and our knowledge about the clinical presentation an course of this entity is limited.
Objectives To describe variable clinical presentation and radiological appearance of SD in AS.
Methods We describe demographic data, medical history, clinical and radiological findings including thoracolumbar spinal magnetic resonance imaging (MRI) in sixteen patients diagnosed as SD with AS admitted to our rheumatology department. All patients fulfilled the modified New York criteria and ASAS criteria for AS.
Results Mean age of patients was 42±12.7. Fourteen patients (88%) were male. Mean disease duration were 6±4.2. Ten patients (63%) were HLA-B27 positive. Three patients had a history of uveitis. SD lesions were commonly seen in thoracolumbar junction. These were characterized by hyperintense discovertebral end-plate changes in T2-weighted and STIR images and by hypointense discovertebral endplate changes in noncontrast T1 - weighted images in MRI. Thirteen patients (81%) had multiple lesions. Nine patients (56%)also had multiple Romanus lesions;in addition 1 patient had costovertebral arthritis and 2 patients had facet joint arthritis. SD was the first symptom of AS in two patients. One patient had misdiagnosed as bone metastases. Biologic agent treatment interrupted in two patients due to incorrect initial diagnosis as tuberculosis discitis and disease activity increased due to misdiagnosis. Fourteen patients (88%) had good response to conservative treatment. Two patients had surgery due to instability of the spinal column.
Conclusions SD is the one of the serious complications of AS since iy may lead to mortality due to spinal fractures. SD could be first symptom of AS and patients may be misdiagnosed could as bone metastases and infectious discitis. Early diagnosis is imperative to prevent spinal fractures or pseudoarthrosis by starting anti-inflammatory treatment immediately.
De Vries MK1, van Drumpt AS, van Royen BJ, van Denderen JC, Manoliu RA, van der Horst-Bruinsma IE. Discovertebral (Andersson) lesions in severe ankylosing spondylitis: a study using MRI and conventional radiography. Clin Rheumatol. 2010 Dec;29(12):1433-8. doi: 10.1007/s10067-010-1480-9. Epub 2010 May 23.
Bron JL1, de Vries MK, Snieders MN, van der Horst-Bruinsma IE, van Royen BJ. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol. 2009 Aug;28(8):883-92. doi: 10.1007/s10067-009-1151-x. Epub 2009 Mar 18.
Manimegalai N, KrishnanKutty K, Panchapakesa Rajendran C, Rukmangatharajan S, Rajeswari S. Andersson Lesion in Ankylosing Spondylitis. JK Science, Vol. 6 No. 2, April-June 2004.
Disclosure of Interest None declared
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