IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany.
BMC Musculoskelet Disord. 2022 Aug 1;23(1):735. doi: 10.1186/s12891-022-05686-y.
Rapidly Destructive Osteoarthritis (RDOA) has been described for the hip and shoulder joints and is characterized by a quickly developing bone edema followed by extensive remodeling and joint destruction. Confronted with a similarly evolving case of endplate edema and destruction of the disk space, we offer the first described case of spinal RDOA and illustrate the challenges it presented, along with the strategies we put in place to overcome them.
We present a case of spinal RDOA that, also due to the delay in the diagnoses, underwent multiple revisions for implant failure with consequent coronal and sagittal imbalance. A 37-years-old, otherwise healthy female presented with atraumatic low back pain: after initial conservative treatment, subsequent imaging showed rapidly progressive endplate erosion and a scoliotic deformity. After surgical treatment, the patient underwent numerous revisions for pseudoarthrosis, coronal and sagittal imbalance and junctional failure despite initially showing a correct alignement after each surgery. As a mechanic overload from insufficient correction of the alignement of the spine was ruled out, we believe that the multiple complications were caused by an impairment in the bone structure and thus, reviewing old imaging, diagnosed the patient with spinal RDOA. In case of spinal RDOA, particular care should be placed in the choice of extent and type of instrumentation in order to prevent re-intervention.
Spinal RDOA is characterized by a quickly developing edema of the vertebral endplates followed by a destruction of the disk space within months from the first diagnosis. The disease progresses in the involved segment and to the adjacent disks despite surgical therapy. The surgical planning should take the impaired bone structure account and the use of large interbody cages or 4-rod constructs should be considered to obtain a stable construct.
快速破坏性骨关节炎（RDOA）已在髋关节和肩关节中被描述，其特征是迅速发展的骨水肿，随后是广泛的重塑和关节破坏。在面对一个类似的进展性终板水肿和椎间盘空间破坏的病例时，我们提供了首例脊柱 RDOA 的描述性病例，并说明了它所带来的挑战，以及我们为克服这些挑战而采取的策略。
我们介绍了一例脊柱 RDOA 病例，由于诊断延误，该病例经历了多次植入物失败的翻修，导致冠状和矢状面失衡。一名 37 岁、健康状况良好的女性出现无创伤性腰痛：初始保守治疗后，后续影像学显示终板迅速进行性侵蚀和脊柱侧凸畸形。手术治疗后，尽管每次手术后患者的排列都得到了正确的矫正，但仍因假关节、冠状和矢状面失衡以及交界处失败而经历了多次翻修。由于机械性过载是由脊柱排列矫正不足引起的可能性被排除，我们认为，这些多次并发症是由骨结构受损引起的，因此，回顾旧的影像学，诊断该患者患有脊柱 RDOA。在脊柱 RDOA 的情况下，应特别注意选择器械的范围和类型，以防止再次干预。
脊柱 RDOA 的特征是在最初诊断后的数月内，椎体终板迅速发展的水肿，随后是椎间盘空间的破坏。尽管进行了手术治疗，疾病仍在受累节段和相邻椎间盘进展。手术规划应考虑到受损的骨结构，并应考虑使用大的椎间笼或 4 棒结构来获得稳定的结构。
