Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2021 Nov 30;12:766209. doi: 10.3389/fendo.2021.766209. eCollection 2021.
Andersson lesions (ALs) in ankylosing spondylitis (AS) pose a severe risk to the stability of ankylosed spine, which might result in significant deterioration of spinal cord function after traumatic or inflammatory causes. Herein, erosive discovertebral lesions in diffuse idiopathic skeletal hyperostosis (DISH) presented important clinical similarities to AL in AS, but failed to completely recognize unstable spinal lesions. Therefore, we pioneered to identify spinal discovertebral lesions similar to Andersson-like lesions (ALLs) in DISH, followed by the characterization and summarization of the etiology, radiology, laboratory results, clinical symptoms, and treatment strategies for AL in AS with ALL in DISH. By characterizing the ALL in DISH cases, we showed that the ALL was mainly traumatic and established at the junction of focal stress between two adjacent ossified level arms. Erosive discovertebral ALLs were formed after trivial stress of direct impact and could be subdivided into transdiscal, transvertebral, and discovertebral types radiologically. Patients who presented with ALL frequently suffered from consistent back pain clinically and experienced a decrease in motion ability that could reflect skeletal stability, which received treatment effectiveness after conservative external spinal immobilization or further surgical internal fixation, indicating the significance of recognizing ALL in the ankylosed DISH spine to further maintain spinal stability in order to prevent catastrophic neurologic sequelae. Our work highlighted the clinical relevance of ALL in DISH in comparison with AL in AS, which provided broader insight to identify ALL in DISH, thus facilitating early intervention against DISH deterioration.
强直性脊柱炎（AS）中的安德森病变（AL）对强直性脊柱的稳定性构成严重威胁，这可能导致创伤或炎症原因后脊髓功能显著恶化。在此，弥漫性特发性骨肥厚症（DISH）中的侵蚀性椎体病变与 AS 中的 AL 具有重要的临床相似性，但未能完全识别不稳定的脊柱病变。因此，我们率先在 DISH 中识别出类似于安德森样病变（ALL）的脊柱椎体病变，随后对 AS 中的 AL 和 DISH 中的 ALL 的病因、影像学、实验室结果、临床症状和治疗策略进行了特征描述和总结。通过对 DISH 中 ALL 病例的特征描述，我们发现 ALL 主要是创伤性的，发生在两个相邻骨化水平臂之间的局部应力交界处。在直接撞击的微小应力下形成侵蚀性椎体 ALL，可根据影像学分为经椎间盘、经椎体和椎体间类型。临床上经常出现 ALL 的患者表现为持续性背痛，并经历运动能力下降，这反映了骨骼稳定性，在接受保守的脊柱外部固定或进一步的手术内固定治疗后，其治疗效果明显，这表明在强直性 DISH 脊柱中识别 ALL 以进一步维持脊柱稳定性，从而预防灾难性的神经后遗症具有重要意义。我们的工作强调了 DISH 中 ALL 与 AS 中 AL 的临床相关性，这为识别 DISH 中的 ALL 提供了更广泛的见解，从而有助于早期干预 DISH 的恶化。
