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European Spine Journal

, Volume 20, Issue 9, pp 1503–1509 | Cite as

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

  • Bharat R. Dave
  • Himanshu Ram
  • Ajay KrishnanEmail author
Original Article

Abstract

This study reviews the presentation, etiology, imaging characteristics and reasons for missed diagnosis of Andersson lesion (AL) and analyzes the surgical results of short segment fixation in the thoracolumbar region. This is a retrospective single center study. Fourteen patients (15 lesions) who were operated for AL were analyzed. The study was designed in two parts. The first part consisted of analysis of clinical and radiological features (MRI and radiographs) to highlight, whether definitive characteristics exist. The second part consisted of analysis of outcome of short segment fixation as measured by VAS, Frankel score, AsQoL index, and union, with assessment of complications. The follow-up was 42.33 ± 19.29 months (13 males and 1 female) with a mean age of 61.13 ± 19.74 years. There was predisposing trauma in five patients. There was a delay in presentation of the patients by 5.86 ± 2.50 months. There was misdiagnosis in all the cases, at primary orthopedic level (ten cases were put on anti-tuberculous treatment due to its MRI resemblance to infection) and all but one case at radiologist level. Radiographs and MRI had characteristic features in all cases, and MRI could detect posterior element affection in 14 lesions as against only 8 posterior lesions detected in radiographs. In all patients, there was a patient’s delay and/or physician’s delay to arrive at a diagnosis. Spinal fusion was seen in all the cases. Outcome measures of VAS, Frankel score, and AsQoL index showed significant improvement (P < 0.002). No major complications occurred. There is a lack of awareness of AL leading to misdiagnosis. Definite clinico-radiological features do exist in AL and short segment fixation is effective.

Keywords

Andersson lesion Ankylosing spondylitis Short segment Posterior fixation 

Notes

Conflict of interest

None.

References

  1. 1.
    Johannes LB, Mirjam KV, Marieke NS, Irene EVHB, Barend JVR (2009) Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 28:883–892CrossRefGoogle Scholar
  2. 2.
    Fang D, Leong J, Ho EKE et al (1988) Spinal pseudoarthrosis in ankylosing spondylitis, clinicopathological correlation and the results of anterior spinal fusion. J Bone Jt Surg Br 70:443–447Google Scholar
  3. 3.
    Bot SD, Caspers M, Van Royen BJ et al (1999) Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology (Oxf) 38:441–443CrossRefGoogle Scholar
  4. 4.
    Olerud C, Frost A, Bring J (1996) Spinal fractures with ankylosing spondylitis. Eur Spine J 5:51–55PubMedCrossRefGoogle Scholar
  5. 5.
    van der Horst-Bruinsma IE (2006) Clinical aspects of ankylosing spondylitis. In: van Royen BJ, Dijkmans BAC (eds) Ankylosing spondylitis. Diagnosis and management. Taylor and Francis, New York, pp 45–70Google Scholar
  6. 6.
    Fox MW, Onofrio BM, Kilgore JE (1993) Neurological complications of ankylosing spondylitis. J Neurosurg 78:871–878PubMedCrossRefGoogle Scholar
  7. 7.
    Mundwiler LM, Siddique K, Dym JM, Perri B, Johnson JP, Weisman MH (2008) Complications of the spine in ankylosing spondylitis with a focus on deformity correction. Neurosurg Focus 24(1):1–9CrossRefGoogle Scholar
  8. 8.
    Chang K-W, Tu M-Y, Huang H-H, Chen H-C, Chen Y-Y, Lin C-C (2006) Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine 31(13):E408–E413PubMedCrossRefGoogle Scholar
  9. 9.
    Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15:S17–S24PubMedCrossRefGoogle Scholar
  10. 10.
    Frankel HL, Hancock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia I 7:179–192CrossRefGoogle Scholar
  11. 11.
    Zhao LK, Liao ZT, Li CH, Li TW et al (2007) Evaluation of quality of life using ASQoL questionnaire in patients with ankylosing spondylitis in a Chinese population. Rheumatol Int 27:605–611PubMedCrossRefGoogle Scholar
  12. 12.
    Simmons E, Goodwin CB (1984) Spondylodiscitis, manifestation of in ankylosing spondylitis. Orthop Trans 8:165–171Google Scholar
  13. 13.
    Peh WC, Luk KD (1994) Pseudoarthrosis in ankylosing spondylitis. Ann Rheum Dis 53:206–210PubMedCrossRefGoogle Scholar
  14. 14.
    Dihlmann W, Delling G (1978) Disco-vertebral destructive lesions (socalled Andersson lesions) associated with ankylosing spondylitis. Skeletal Radiol 3:10–16CrossRefGoogle Scholar
  15. 15.
    Eschelman DJ, Beers GJ, Naimark A, Yablon I (1991) Pseudoarthrosis in ankylosing spondylitis mimicking infectious diskitis: MR appearance. Am J Neuroradiol 12(6):1113–1114PubMedGoogle Scholar
  16. 16.
    Kabasakal Y, Garret SL, Calin A (1996) The epidemiology of spondylodiscitis in ankylosing spondylitis-a controlled study. Br J Rheumatol 35(7):660–663PubMedCrossRefGoogle Scholar
  17. 17.
    Whang PG, Goldberg G, Lawrence JP et al (2009) The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes. J Spinal Disord Tech 22:77–85PubMedCrossRefGoogle Scholar
  18. 18.
    Cawley MI, Chalmers TM, Kellgren JH et al (1972) Destructive lesions of vertebral bodies in ankylosing spondylitis. Ann Rheum Dis 31:345PubMedCrossRefGoogle Scholar
  19. 19.
    Wang Y-F, Teng MM-H, Chang C-Y, Wu H-T, Wang S-T (2005) Imaging manifestations of spinal fractures in ankylosing spondylitis. AJNR Am J Neuroradiol 26:2067–2076PubMedGoogle Scholar
  20. 20.
    Shih TF, Chen PQ, Li YW, Hsu CY (2001) Spinal fractures and pseudoarthrosis complicating ankylosing spondylitis: MRI manifestation and clinical significance. J Comput Assist Tomogr 25:164–170PubMedCrossRefGoogle Scholar
  21. 21.
    De Ross A, Van Meerten EL, Bloem JL, Bluemm RG (1986) MRI of tuberculosis spondylitis. Am J Roentgenol 146:79–82Google Scholar
  22. 22.
    Modic MT, Feiglin DH, Piraindo DW et al (1985) Vertebral osteomyelitis: assessment by MR. Radiology 157:157–166PubMedGoogle Scholar
  23. 23.
    Park WM, Spencer DG, McCall IW, Ward J, Buchanan WW, Stephens WH (1981) The detection of spinal pseudarthrosis in ankylosing spondylitis. Br J Radiol 54(642):467–472PubMedCrossRefGoogle Scholar
  24. 24.
    Rasker JJ, Prevo RL, Lanting PJ (1996) Spondylodiscitis in ankylosing spondylitis, inflammation or trauma? A description of six cases. Scand J Rheumatol 25(1):52–57PubMedCrossRefGoogle Scholar
  25. 25.
    Ha KY, Cho HL (1998) Andersson lesion in ankylosing spondylitis: a case report. Korean Soc Spine Surg 5(1):148–153Google Scholar
  26. 26.
    Escosa-Bage M, Garcia-Navarrete E, Pascual-Garvi meetings JM, Sola RG (2001) Surgical treatment of spondylodiscitis in ankylosing spondylitis Report of two cases. Rev neurol 33:964–966PubMedGoogle Scholar
  27. 27.
    Jayaswal A (2003) Pseudarthrosis in ankylosing spondylitis. Abstract from the SRS Annual MeetingGoogle Scholar
  28. 28.
    Krishnan A, Karunagaran, Hegde S (2009) Surgical outcome in ankylosing spondylitis patients with Andersson’s lesion and neurological deficit. J Bone Jt Surg(Br) 91-B(Supp_III):483Google Scholar
  29. 29.
    Serin E, Karakurt L, Yilmaz E, Belhan O, Varol T (2004) Effects of two-levels, four-levels, and four-levels plus offset-hook posterior fixation techniques on protecting the surgical correction of unstable thoracolumbar vertebral fractures: a clinical study. Eur J Orthop Surg Traumatol 14:1–6CrossRefGoogle Scholar
  30. 30.
    Tezeren G, Kuru I (2005) Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech 18:485–488PubMedCrossRefGoogle Scholar
  31. 31.
    Kim KT, Lee SH, Suk KS, Lee JH, Im YJ (2007) Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity. Clinical characteristics and outcome analysis. Spine 32 15(1):641–1647Google Scholar
  32. 32.
    Hornick TR (2006) Surgical innovations: impact on the quality of life of the older patient. Clin Geriatr Med 22:499–513PubMedCrossRefGoogle Scholar
  33. 33.
    Murray A, Persellin RH (1981) Cervical fracture complicating ankylosing spondylitis: a report of eight cases and review of the literature. Am J Med 70:1033–1041PubMedCrossRefGoogle Scholar
  34. 34.
    Gold RH, Bassett LW, Seeger LL (1988) The other arthritides. Roentgenologic fractures osteoarthritis, erosive osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, multi-centric reticulohistiocytosis, and progressive systemic sclerosis. Radiol Clin North Am 26:1195–1212PubMedGoogle Scholar
  35. 35.
    Samartzis D, Anderson DG, Shen FH (2005) Multiple and simultaneous spine fractures in Ankylosing spondylitis: case report. Spine 30:E711–E715PubMedCrossRefGoogle Scholar
  36. 36.
    Wade W, Saltzstein R, Maiman D (1989) Spinal fractures complicating ankylosing spondylitis. Arch Phys Med Rehabil 70:398–401PubMedGoogle Scholar
  37. 37.
    Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment neurological status and complications. Eur Spine J 18:145–156PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Stavya Spine Hospital and Research InstituteAhmedabadIndia

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