Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation

Dave, Bharat R; Ram, Himanshu; Krishnan, Ajay

doi:10.1007/s00586-011-1836-0

Cited by 31 publications

(29 citation statements)

References 31 publications

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“…[4][5][6] There have been several reports describing the clinical and radiological findings of this condition. [1][2][3]7,8 However, no reports have analyzed the clinical characteristics combined with a complete set of radiological examination (including plain film, CT with reconstruction and MRI) in a relative large series because of the rarity of this condition. In this report, we respectively reviewed the clinical and radiological features of thoracolumbar pseudarthrosis in AS in a consecutive cohort of patients.…”

Section: Introductionmentioning

confidence: 99%

Thoracolumbar pseudarthrosis in ankylosing spondylitis

Wang¹,

Liu²,

Jiang³

et al. 2018

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Study design: Retrospective study of a series of 36 consecutive patients with thoracolumbar pseudarthrosis in ankylosing spondylitis (AS). Objective: To analyze the clinical and radiological characteristics, especially the computed tomography (CT) with multiplanar reformations, of thoracolumbar pseudarthrosis in AS. A new classification of thoracolumbar pseudarthrosis in AS was put forward. Summary of background data: Spinal pseudarthrosis (SP) is a well recognized complication in advanced AS. Its features are similar to infective spondylitis, so this may often result in misdiagnosis. The clinical and radiological characteristics (including plain film, CT with reconstruction and MRI) in a relative large series have not been reported because of the rarity of this condition. Methods: During the period between Jan 2003 to Jan 2016, 36 patients with AS complicated thoracolumbar pseudarthrosis were treated in our department. Clinically, history of trauma and characteristics of symptoms were obtained by patient interviews. Radiologic assessment including plain film, CT with reconstruction and MRI were obtained in all patients. Their clinical and radiological characteristics were analyzed. A classification based on the CT with reconstruction was put forward. Results: There were 31 males and 5 females, with an average age of 50.1 years (range 33 to 77 years). The diagnosis in all cases was further confirmed when the patients received surgery because of failure of conservative treatment. All of them complained of recurrent back pain and 12 complicated neurological deficits. Most lesions were near the thoracolumbar junction. There were two type of pseudarthrosis, trans-disc type and trans-vertebral type, based on the sclerotic bony gap of the pseudarthrosis. Twenty-eight of the 36 pseudarthrosis were trans-disc type and the other 8 were trans-vertebral type. Precedent traumatic events were found in all 8 cases with transvertebral type. Eighteen of 28 trans-disc type were found to have the characteristic of extensive discovertebral destruction on radiograph, but the other 18 cases (including 10 cases with trans-disc type and all 8 cases with trans-vertebral type) needed further radiological examinations for the diagnosis. CT with multiplanar reformation clearly characterized the pseudarthrosis, which showed continuous sclerotic bony gap through the three columns of thoracolumbar junction in all cases. MRI is superior in depicting spinal cord compression. The pathology further confirmed the diagnosis of SP in AS. Conclusion: Two types of thoracolumbar pseudarthrosis, the trans-disc type and transvertebral type, can been identified in AS. More than half of the cases with trans-disc pseudarthrosis have the manifestation of extensive discovertebral destructive lesions on plain film. The continuous sclerotic gap across all columns of the spine showed on reformatted CT images is the characteristic of SP in AS. MRI is valuable in evaluating the spinal cord and the nerve roots in the cases with neurological deficits.

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Section: Introductionmentioning

confidence: 99%

Thoracolumbar pseudarthrosis in ankylosing spondylitis

Wang¹,

Liu²,

Jiang³

et al. 2018

MOJOR

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“…However, the optimal procedure for this problem is still controversial [7]. Several surgical treatments for AL have been advocated, including posterior fusion, anterior fusion, and a combined approach [4, 8–11].…”

Section: Introductionmentioning

confidence: 99%

Posterior wedge osteotomy and debridement for Andersson lesion with severe kyphosis in ankylosing spondylitis

et al. 2017

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BackgroundAndersson lesion is a well-known complication in ankylosing spondylitis. Recently, owing to the worry about the healing of fracture, some scholars advocated additional anterior surgery or other procedures were necessary, which increase the risk of the nerve injury. The purpose of this study is to introduce our experience and to explore the efficacy and feasibility of posterior wedge osteotomy and debridement through Andersson Lesion for surgical treatment of severe kyphosis in ankylosing spondylitis.MethodsFrom January 2012 to January 2014, a retrospective study of 14 Andersson lesion patients with severe kyphosis in ankylosing spondylitis treated with surgery was completed with an at least 2-year follow-up. The debridement procedure, before posterior wedge osteotomy in posterior approach, must scrape all sclerosis bone until healthy cancellous bone appears. Radiographic and clinical results and complications were assessed with an average follow-up of 24 months. The CT scan was obtained preoperatively and at the final follow-up to assess the displacement of the fracture preoperatively, the safety of screw insertion, the healing of the fracture at the final follow-up. The Bridwell interbody fusion grading system was used to assess the healing of the fracture.ResultsLocal kyphosis was substantially corrected from 51.7 ± 15.6 to 7.1 ± 19.5, with a mean correction of 44°. The global kyphosis (GK) changed from 60.6 ± 28.3 to 20.3 ± 10.3 (P = 0.000). The mean VAS back pain scores decreased from 6.7 ± 0.8 preoperatively to 0.75 ± 0.6 after a 2-year follow-up (P = 0.000). The ODI score improved from 60.56 ± 15.1% preoperatively to 23.46 ± 8.2% after a 2-year follow-up (P = 0.000). The CT scan showed solid fusion at the level of the AL, and no internal fixation loose. All patients achieved grade 1 fusion. No major complication occurred.ConclusionsThe posterior wedge osteotomy and debridement through AL can be used to correct the severe kyphosis in ankylosing spondylitis, achieving favorable clinical outcomes, good fusion, and satisfactory deformity correction.

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“…These findings suggestive of disc infections, are quite unusual in such cases, particularly in vertebral fracture. However, a well-known complication in patients with ankylosing spondylitis is the development of discovertebral lesions (Andersson lesions) that result from inflammation or fractures of the completely ankylosed spine [2]. Andersson lesions can exhibit inflammatory discovertebral changes with bone marrow oedema [2,3].…”

mentioning

confidence: 99%

“…However, a well-known complication in patients with ankylosing spondylitis is the development of discovertebral lesions (Andersson lesions) that result from inflammation or fractures of the completely ankylosed spine [2]. Andersson lesions can exhibit inflammatory discovertebral changes with bone marrow oedema [2,3]. In this setting, MRI has been proven to be useful in the differential diagnosis in relation to infectious spondylodiscitis.…”

mentioning

confidence: 99%