BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral bo...BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral body and/or the area involving the intervertebral disc.According to the literature,Andersson lesion commonly occur in the thoracic and lumbar spine and rarely in the cervical spine.CASE SUMMARY This case involved a 78-year-old man with a long history of AS who developed AL in the cervical spine(C5/6 and C6/7).One-stage anterior-posterior approach surgery was successfully performed.At the 6-month follow-up,the pain was significantly reduced,and the limb function was gradually improved.CONCLUSION AL uncharacteristically appears in the cervical spine and tends to be misdiagnosed as vertebral metastases or spinal tuberculosis.Posterior combined with anterior surgery achieves solid biological stabilization in the treatment of AL bone destruction.展开更多
Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes hav...Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes have been proposed to define this lesion.Different surgical approaches including anterior,posterior,and combined anterior and posterior procedure have been used to address the complications,consisting of mechanical pain,kyphotic deformity,and neurologic deficits.However,the preferred surgical procedure remains controversial.The aim of this study was to illustrate the safety,efficacy,and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.Methods:From June 2008 to January 2013,23 patients(18 males,5 females)at an average age of 44.8 years(range 25–69 years)were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department.All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the followup period.Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system.Ankylosing spondylitis quality of life(ASQoL)and visual analog scale(VAS)scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively.Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons.The radiographic data change was evaluated by repeated measure analysis of variance.Results:The mean operative duration was 205.4 min(range 115–375 min),with an average blood loss of 488.5 mL(range 215–880 mL).Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up.The VAS back pain and ASQoL scores improved significantly in all patients(7.52±1.31 vs.1.70±0.70,t=18.30,P<0.001;13.87±1.89 vs.7.22±1.24,t=18.53,P<0.001,respectively).The thoracolumbar kyphosis(TLK)changed from 40.03±17.61°pre-operatively to 13.86±6.65°post-operatively,and 28.45±6.63°at final follow-up(F=57.54,P<0.001),the thoracic kyphosis(TK)changed from 52.30±17.62°pre-operatively to 27.76±6.50°post-operatively,and 28.45±6.63°at final follow-up(F=57.29,P<0.001),and lumbar lordosis(LL)changed from29.56±9.73°pre-operatively to20.58±9.71°post-operatively,and20.73±10.27°at final follow-up(F=42.50,P<0.001).Mean sagittal vertical axis(SVA)was improved from 11.82±4.55 cm pre-operatively to 5.12±2.42 cm post-operatively,and 5.03±2.29 cm at final follow-up(F=79.36,P<0.001).No obvious loss of correction occurred,according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients(TK:27.76±6.50°vs.28.45±6.63°,TLK:13.86±6.65°vs.14.42±6.7°,LL:20.58±9.71°vs.20.73±10.27°,and SVA:5.12±2.42 cm vs.5.03±2.29 cm,all P>0.05,respectively).Conclusions:The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction,solid fusion,and good clinical outcomes.展开更多
Background:Andersson lesions(ALs)are not uncommon in ankylosing spondylitis(AS).Plain radiography(PR)is widely used for the diagnosis of ALs.However,in our practice,there were some ALs in AS patients that could not be...Background:Andersson lesions(ALs)are not uncommon in ankylosing spondylitis(AS).Plain radiography(PR)is widely used for the diagnosis of ALs.However,in our practice,there were some ALs in AS patients that could not be detected on plain radiographs.This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.Methods:A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital,Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed.The AS patients with ALs who met the following criteria were included for the investigation of occult ALs:(1)with pre-operative plain radiographs of the whole-spine and(2)availability of pre-operative computed tomography(CT)and/or magnetic resonance imaging(MRI)of the whole-spine.The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI.The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body.Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs.Chi-square or Fisher exact test was applied to compare the types,distribution,and radiographic characteristics between detectable and occult ALs as appropriate.Results:Ninety-two AS patients with a mean age of 44.4±10.1 years were included for the investigation of occult ALs.Twenty-three patients had occult ALs and the incidence was 25%(23/92).Fifteen extensive ALs were occult,and the proportion of extensive ALs was significantly higher in detectable ALs(97%vs.44%,χ^(2)=43.66,P<0.001).As assessed by PR,the proportions of osteolytic destruction with reactive sclerosis(0 vs.100%,χ^(2)=111.00,P<0.001),angular kyphosis of the affected discovertebral units or vertebral body(0 vs.22%,χ^(2)=8.86,P=0.003),formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament(38%vs.86%,χ^(2)=25.91,P<0.001),and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs(9%vs.84%,χ^(2)=60.41,P<0.001).Conclusions:Occult ALs presented with more subtle radiographic changes.Occult ALs should not be neglected,especially in the case of extensive occult ALs,because the stability of the spine might be severely impaired by these lesions.展开更多
基金Supported by the National Natural Science Foundation of China,No. 81902239the Natural Science Foundation of Jiangsu Province,No. BK20191169
文摘BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral body and/or the area involving the intervertebral disc.According to the literature,Andersson lesion commonly occur in the thoracic and lumbar spine and rarely in the cervical spine.CASE SUMMARY This case involved a 78-year-old man with a long history of AS who developed AL in the cervical spine(C5/6 and C6/7).One-stage anterior-posterior approach surgery was successfully performed.At the 6-month follow-up,the pain was significantly reduced,and the limb function was gradually improved.CONCLUSION AL uncharacteristically appears in the cervical spine and tends to be misdiagnosed as vertebral metastases or spinal tuberculosis.Posterior combined with anterior surgery achieves solid biological stabilization in the treatment of AL bone destruction.
文摘Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes have been proposed to define this lesion.Different surgical approaches including anterior,posterior,and combined anterior and posterior procedure have been used to address the complications,consisting of mechanical pain,kyphotic deformity,and neurologic deficits.However,the preferred surgical procedure remains controversial.The aim of this study was to illustrate the safety,efficacy,and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.Methods:From June 2008 to January 2013,23 patients(18 males,5 females)at an average age of 44.8 years(range 25–69 years)were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department.All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the followup period.Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system.Ankylosing spondylitis quality of life(ASQoL)and visual analog scale(VAS)scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively.Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons.The radiographic data change was evaluated by repeated measure analysis of variance.Results:The mean operative duration was 205.4 min(range 115–375 min),with an average blood loss of 488.5 mL(range 215–880 mL).Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up.The VAS back pain and ASQoL scores improved significantly in all patients(7.52±1.31 vs.1.70±0.70,t=18.30,P<0.001;13.87±1.89 vs.7.22±1.24,t=18.53,P<0.001,respectively).The thoracolumbar kyphosis(TLK)changed from 40.03±17.61°pre-operatively to 13.86±6.65°post-operatively,and 28.45±6.63°at final follow-up(F=57.54,P<0.001),the thoracic kyphosis(TK)changed from 52.30±17.62°pre-operatively to 27.76±6.50°post-operatively,and 28.45±6.63°at final follow-up(F=57.29,P<0.001),and lumbar lordosis(LL)changed from29.56±9.73°pre-operatively to20.58±9.71°post-operatively,and20.73±10.27°at final follow-up(F=42.50,P<0.001).Mean sagittal vertical axis(SVA)was improved from 11.82±4.55 cm pre-operatively to 5.12±2.42 cm post-operatively,and 5.03±2.29 cm at final follow-up(F=79.36,P<0.001).No obvious loss of correction occurred,according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients(TK:27.76±6.50°vs.28.45±6.63°,TLK:13.86±6.65°vs.14.42±6.7°,LL:20.58±9.71°vs.20.73±10.27°,and SVA:5.12±2.42 cm vs.5.03±2.29 cm,all P>0.05,respectively).Conclusions:The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction,solid fusion,and good clinical outcomes.
基金supported by grants from the Jiangsu Provincial Medical Talent Program(No.ZDRCA2016068)the Jiangsu Provincial Key Medical Center(No.YXZXA2016009).
文摘Background:Andersson lesions(ALs)are not uncommon in ankylosing spondylitis(AS).Plain radiography(PR)is widely used for the diagnosis of ALs.However,in our practice,there were some ALs in AS patients that could not be detected on plain radiographs.This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.Methods:A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital,Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed.The AS patients with ALs who met the following criteria were included for the investigation of occult ALs:(1)with pre-operative plain radiographs of the whole-spine and(2)availability of pre-operative computed tomography(CT)and/or magnetic resonance imaging(MRI)of the whole-spine.The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI.The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body.Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs.Chi-square or Fisher exact test was applied to compare the types,distribution,and radiographic characteristics between detectable and occult ALs as appropriate.Results:Ninety-two AS patients with a mean age of 44.4±10.1 years were included for the investigation of occult ALs.Twenty-three patients had occult ALs and the incidence was 25%(23/92).Fifteen extensive ALs were occult,and the proportion of extensive ALs was significantly higher in detectable ALs(97%vs.44%,χ^(2)=43.66,P<0.001).As assessed by PR,the proportions of osteolytic destruction with reactive sclerosis(0 vs.100%,χ^(2)=111.00,P<0.001),angular kyphosis of the affected discovertebral units or vertebral body(0 vs.22%,χ^(2)=8.86,P=0.003),formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament(38%vs.86%,χ^(2)=25.91,P<0.001),and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs(9%vs.84%,χ^(2)=60.41,P<0.001).Conclusions:Occult ALs presented with more subtle radiographic changes.Occult ALs should not be neglected,especially in the case of extensive occult ALs,because the stability of the spine might be severely impaired by these lesions.
