Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited

Abstract

A well-known complication in patients with ankylosing spondylitis (AS) is the development of localised vertebral or discovertebral lesions of the spine, which was first described by Andersson in 1937. Since then, many different terms are used in literature to refer to these localised lesions of the spine, including the eponym ‘Andersson lesion’ (AL). The use of different terms reflects an ongoing debate on the exact aetiology of the AL. In the current study, we performed an extensive review of the literature in order to align communication on aetiology, diagnosis and management between treating physicians. AL may result from inflammation or (stress-) fractures of the complete ankylosed spine. There is no evidence for an infectious origin. Regardless of the exact aetiology, a final common pathway exists, in which mechanical stresses prevent the lesion from fusion and provoke the development of pseudarthrosis. The diagnosis of AL is established on conventional radiography, but computed tomography and magnetic resonance imaging both provide additional information. There is no indication for a diagnostic biopsy. Surgical instrumentation and fusion is considered the principle management in symptomatic AL that fails to resolve from a conservative treatment. We advise to use the term Andersson lesion for these spinal lesions in patients with AS.

Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis

“…In the advanced AS patients with complete ankylosed spine, with increased stresses in the thoracolumbar junction, a stress fracture can occur with minor trauma or even without any trauma [19,21,24]. As the stress fracture level is always the last mobile joint between two ankylosed spinal segments, the continued movement at the fracture site eventually contributes to the development of pseudarthrosis [2,20]. In the current series, all patients had 3-column involved pseudarthrosis through the disc space at the thoracolumbar junction, located from T11 to L1 (Table 1).…”

“…Its surgical indication has been well documented in literature [2,4,16,23]. Most authors have reached a consensus that the goal of the surgical treatment is to achieve a successful arthrodesis of pseudarthrosis, and to restore spinal stability and sagittal balance [16,23].…”

Discovertebral (Andersson) lesion of the Ankylosing Spondylitis, a cause of autonomic dysreflexia in spinal cord injury

“…6 These localized discovertebral lesions of the spine, 'ALs' are also known as 'destructive vertebral lesions', pseudoarthrosis' or '(stress-) fracture'. 6 The reported prevalence of AL or discovertebral lesions complicating AS, ranges from 1.5% to over 28%. AL is most commonly found in middle-aged patient population (63-86%) with long-standing AS.…”

“…AL is most commonly found in middle-aged patient population (63-86%) with long-standing AS. Bron et al 6 pointed out that AL can be either transdiscal or transvertebral, and is usually accompanied by fractures or non-fusion of the posterior elements of the spine. Extensive AL/ pseudoarthrosis develop due to both active inflammation and mechanical factors (trauma/ stress).…”

“…The AL is revealed by osteolytic destruction with a surrounding zone of reactive sclerosis and vertebral osteophytes. 6 AD is frequently associated with bladder or bowel distension, urinary tract infection, pressure sore, hemorrhoid, anal fissure, paronychia or it can be triggered by any activation of pain receptors below the level of injury. [7][8][9] Here we present a case report of a patient with AS with complete high SCI, developed AD, triggered by AL in ankylosed lumbar spine and her rehabilitation perspectives.…”