The Andersson lesion in ankylosing spondylitis: DISTINGUISHING BETWEEN THE INFLAMMATORY AND TRAUMATIC SUBTYPES

• Published in: Journal of bone and joint surgery. British volume Vol. 93; no. 7; pp. 961 - 966
• Main Authors: PARK, Y.-S, KIM, J.-H, RYU, J.-A, KIM, T.-H
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.07.2011
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Diagnosis, Differential; Discitis - diagnosis; Discitis - etiology; Diseases of the osteoarticular system; Female; Humans; Inflammatory joint diseases; Injuries of the limb. Injuries of the spine; Kyphosis - diagnostic imaging; Kyphosis - etiology; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - injuries; Lumbar Vertebrae - pathology; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Orthopedic surgery; Radiography; Retrospective Studies; Scoliosis - diagnostic imaging; Scoliosis - etiology; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - diagnosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - injuries; Thoracic Vertebrae - pathology; Traumas. Diseases due to physical agents; Young Adult; Spondylarthropathy; Chronic; Orthopedic surgery; Treatment; Diseases of the osteoarticular system; Inflammatory joint disease; Inflammation; Spine disease; Lesion; Subtype; Trauma; Ankylosing spondylitis
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.93B7.26337

A number of causes have been advanced to explain the destructive discovertebral (Andersson) lesions that occur in ankylosing spondylitis, and various treatments have been proposed, depending on the presumed cause. The purpose of this study was to identify the causes of these lesions by defining their clinical and radiological characteristics. We retrospectively reviewed 622 patients with ankylosing spondylitis. In all, 33 patients (5.3%) had these lesions, affecting 100 spinal segments. Inflammatory lesions were found in 91 segments of 24 patients (3.9%) and traumatic lesions in nine segments of nine patients (1.4%). The inflammatory lesions were associated with recent-onset disease; a low modified Stoke ankylosing spondylitis spine score (mSASSS) due to incomplete bony ankylosis between vertebral bodies; multiple lesions; inflammatory changes on MRI; reversal of the inflammatory changes and central bony ankylosis at follow-up; and a good response to anti-inflammatory drugs. Traumatic lesions were associated with prolonged disease duration; a high mSASSS due to complete bony ankylosis between vertebral bodies; a previous history of trauma; single lesions; nonunion of fractures of the posterior column; acute kyphoscoliotic deformity with the lesion at the apex; instability, and the need for operative treatment due to that instability. It is essential to distinguish between inflammatory and traumatic Andersson lesions, as the former respond to medical treatment whereas the latter require surgery.