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FRI0454 M-SASSS and cervical segment C7-D1. should the original score be modified?
  1. MJ Moreno-Martinez1,
  2. MJ Moreno-Ramos2,
  3. LF Linares-Ferrando2
  1. 1Rheumatology, H. Rafael Mendez
  2. 2Rheumatology, H. U.Virgen de la Arrixaca, MURCIA, Spain


Background Ankylosing Spondylitis is characterized by axial involvement. m-SASSS is the radiographic score that is used to evaluate the radiographic progression of the disease. It evaluates different lesions in the lumbar segment and in the cervical segment (from C2-C3 to C7-D1), both with a lateral x-ray.

Theoretically, the C7-D1 intervertebral segment should not be evaluated through a simple lateral radiograph, but with x-rays in special positions.

Objectives To evaluate the importance of the assessment of the C7-D1 intervertebral segment in patients with Ankylosing Spondylitis.

Methods The patients come from a Spondyloarthritis Unit (Hospital Virgen of the Arrixaca, Murcia, Spain). All patients are diagnosed with Ankylosing Spondylitis (New York Modified Criteria)

The usual radiographic study was performed to calculate the m-SASSS (lateral cervical and lateral lumbar). We value the alterations found at level C7-D1 of patients and controls.

We compared the alterations found in patients with ankylosing spondylitis with control patients. These came from different rheumatology units, had no inflammatory pathology and had two lateral radiographs at different time periods.

We collected demographic data (both from patients and from controls) and from clinical patients (analytical, activity and metrology).

Results We included 47 patients (81% male and 19% female) with a mean age of 48 (± 8) years and a mean duration of symptoms of 18 (± 8.5) years. The mean time between the two radiographic studies was 3 (± 1.5) years. The control group was made up of 61 people (40, 7% men) with a mean age of 50 years (± 11).

The mean age of the control group was higher than patients (p=0.001).

The C6-C7 intervertebral level could be assessed radiographically with the lateral cervical radiograph in 93,2% of the patients and in 85, 2% of controls, and the C7-D1 level was only assessed in 22, 7% of the patients and 50% of the controls.

We analyzed whether the assessment of intervertebral level C7-D1 could be influenced by other variables such as sex, age or duration from the symptoms without finding a statistical result.

The 88, 5% of patients had a lower border of C7 normal or with squaring, erosion or sclerosis. Only 1 patient had syndesmophyte and 2 patients had a bridge between vertebrae. On the upper border of D1, 85, 5% of patients had normal or type-1 lesions (squarin, sclerosis or erosion), there wasn't syndesmophytes and 2 patients had a bridge (Table)


  • The cervical segment C7-D1 is not usually valuable through a lateral cervical radiograph.

  • Most of our patients with Spondylitis have no significant lesions in this segment.

  • It is recommended to modify the m-SASSS index by removing the assessment of the cervical segment C7-D1.



  1. Averns HL, Oxtoby J, Taylor HG, Jones PW, Dziedzic K, Dawes PT. Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS). Rheumatology.1996;35(4):373–376.

  2. Gil JM, Andrades H, Ramos S. Técnico Especialista en Radiodianόstico Del Servicio Gallego de Salud. 1° Ed. Sevilla. MAD; 2006. 674 p.


Disclosure of Interest None declared

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