The Spine Journal
Andersson lesion in ankylosing spondylitis Andersson lesion (AL) is a destructive vertebral or discovertebral lesion that occurs as a late noninflammatory sequel in ankylosing spondylitis (AS). It is a state of chronic mobile nonunion with an essential posterior element fracture or unfused facet joints associated with the anterior lesion [1–4]. This is a 49-year-old woman with AS and a fixed kyphotic deformity who presented with severe back pain. She had no focal neurologic deficit. Diagnosis of AL is some time difficult because of the preexisting spinal changes, osteoporosis, and radiographic resemblance to infective spondylodiscitis [1]. This is an exemplar case of AL, in which hybrid Singlephoton emission computed tomography/CT imaging showed at T12–L1 intervertebral disc space an extraordinary large vacuum phenomenon with end plate sclerosis and erosion but no scintigraphic abnormality (Figure, A). There was an increased tracer uptake at the right facet joint and lamina and the left facetal heterotopic ossification at this level, demonstrating the potential pain source (Figure, A–C). Magnetic
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(2014)
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resonance imaging scan showed bony exophytic element with mild narrowing of the canal at this level but with no significant compression on the spinal cord or conus (Figure, D). References [1] Johannes LB, Mirjam KV, Marieke NS, et al. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009;28:883–92. [2] Fang D, Leong J, Ho EKE, et al. Spinal pseudarthrosis in ankylosing spondylitis, clinicopathological correlation and the results of anterior spinal fusion. J Bone Joint Surg Br 1988;70:443–7. [3] Bot SD, Caspers M, Royen BJ, et al. Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology (Oxford) 1999;38:441–3. [4] Olerud C, Frost A, Bring J. Spinal fractures with ankylosing spondylitis. Eur Spine J 1996;5:51–5.
Vittorio M. Russo, MD Adrian T. Casey, MD The National Hospital for Neurology and Neurosurgery 33 Queen Square, London WC1N 3BG, UK FDA device/drug status: Not applicable. Author disclosures: VMR: Nothing to disclose. ATC: Nothing to disclose.
Figure. (A) Sagittal SPECT/CT showing at T12–L1 intervertebral disc space an extraordinary large vacuum phenomenon with end plate sclerosis and erosion but no scintigraphic abnormality. (B and C) Axial SPECT/CT showing an increased tracer uptake at the right facet joint and lamina and the left facetal heterotopic ossification at T12–L1 level. (D) Sagittal magnetic resonance imaging showing bony exophytic element with mild narrowing of the canal at T12– L1 level but with no significant compression on the spinal cord or conus. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.02.037
Andersson lesion in ankylosing spondylitis Andersson lesion (AL) is a destructive vertebral or discovertebral lesion that occurs as a late noninflammatory sequel in ankylosing spondylitis (AS). It is a state of chronic mobile nonunion with an essential posterior element fracture or unfused facet joints associated with the anterior lesion [1–4]. This is a 49-year-old woman with AS and a fixed kyphotic deformity who presented with severe back pain. She had no focal neurologic deficit. Diagnosis of AL is some time difficult because of the preexisting spinal changes, osteoporosis, and radiographic resemblance to infective spondylodiscitis [1]. This is an exemplar case of AL, in which hybrid Singlephoton emission computed tomography/CT imaging showed at T12–L1 intervertebral disc space an extraordinary large vacuum phenomenon with end plate sclerosis and erosion but no scintigraphic abnormality (Figure, A). There was an increased tracer uptake at the right facet joint and lamina and the left facetal heterotopic ossification at this level, demonstrating the potential pain source (Figure, A–C). Magnetic
-
(2014)
-
resonance imaging scan showed bony exophytic element with mild narrowing of the canal at this level but with no significant compression on the spinal cord or conus (Figure, D). References [1] Johannes LB, Mirjam KV, Marieke NS, et al. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009;28:883–92. [2] Fang D, Leong J, Ho EKE, et al. Spinal pseudarthrosis in ankylosing spondylitis, clinicopathological correlation and the results of anterior spinal fusion. J Bone Joint Surg Br 1988;70:443–7. [3] Bot SD, Caspers M, Royen BJ, et al. Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology (Oxford) 1999;38:441–3. [4] Olerud C, Frost A, Bring J. Spinal fractures with ankylosing spondylitis. Eur Spine J 1996;5:51–5.
Vittorio M. Russo, MD Adrian T. Casey, MD The National Hospital for Neurology and Neurosurgery 33 Queen Square, London WC1N 3BG, UK FDA device/drug status: Not applicable. Author disclosures: VMR: Nothing to disclose. ATC: Nothing to disclose.
Figure. (A) Sagittal SPECT/CT showing at T12–L1 intervertebral disc space an extraordinary large vacuum phenomenon with end plate sclerosis and erosion but no scintigraphic abnormality. (B and C) Axial SPECT/CT showing an increased tracer uptake at the right facet joint and lamina and the left facetal heterotopic ossification at T12–L1 level. (D) Sagittal magnetic resonance imaging showing bony exophytic element with mild narrowing of the canal at T12– L1 level but with no significant compression on the spinal cord or conus. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.02.037
