Orthopedic Department of General Hospital of Patras Spine and Trauma Unit, Patras, Greece.
Public Health, Postgraduate MSc Program, University of Patras, Patras, Greece.
Spinal Cord Ser Cases. 2022 Aug 9;8(1):73. doi: 10.1038/s41394-022-00541-7.
A relatively rare and unknown entity in patients with ankylosing spondylitis is the Andersson lesion (AL). It was first described by Andersson in 1937 as destructive vertebral or disco-vertebral lesion of the spine without history of trauma. AL may result from inflammation or stress fracture of the rigid spine, while there is no evidence for an infectious origin. To our knowledge, only one case with an infected AL has been published many years ago; we hereby present the second case, but the first one with severe neurologic deterioration.
A 79-year-old male patient was presented to our emergency department and his neurological examination on admission revealed incomplete paraplegia below the Th10 level. Plain radiograms at the level of 10th thoracic vertebra revealed a lesion mimicking a severe vertebral fracture. The computed tomography confirmed the diagnosis of the AL and due to the significant local instability and the neurologic deficit, the patient underwent posterior decompression and stabilization. During decompression, we noticed purulence and extensive debridement was performed. The cultures of the Th10 pus revealed Enterococus sp, while the same pathogen was developed to urine cultures. The patient received intravenous antibiotics for 4 weeks, followed by per os antibiotic therapy. At the 18-month follow-up our patient had significant improvement of this functional status.
Most studies support that inflammatory or traumatic/mechanical (pseudarthrosis) etiology are the most possible causes of Anderson lesions. Possible neurological deterioration should be investigated and demonstrates significant spinal instability. The integrity of the posterior column should be investigated, and exclusion of other concomitant lesions should be done. In cases with instability due to the fractured posterior elements, surgical intervention is mandatory. Spine surgeons should be competent to differentiate fracture from the Andersson lesion. In this rare case we highlight also that spine surgeons should obtain intraoperative cultures in cases with Andersson lesions, to exclude the minor possibility of the infectious origin of the entity and/or the possible secondary contamination of the affected area.
在强直性脊柱炎患者中，安德森病变（AL）是一种相对罕见且不为人知的病变。它于 1937 年由安德森首次描述，为脊柱无创伤史的破坏性椎体或椎间盘椎体病变。AL 可能是由刚性脊柱的炎症或应力性骨折引起的，而没有感染来源的证据。据我们所知，多年前仅发表过一例感染性 AL 病例；在此我们报告第二例病例，但这是首例出现严重神经功能恶化的病例。
一名 79 岁男性患者被收入我院急诊，入院时的神经系统检查显示 T10 以下不完全性截瘫。第 10 胸椎水平的平片显示病变类似于严重的椎体骨折。计算机断层扫描（CT）确认了 AL 的诊断，由于局部明显不稳定和神经功能缺损，患者接受了后路减压和稳定术。在减压过程中，我们注意到有脓液，进行了广泛清创术。T10 脓液培养显示肠球菌，而同一病原体也培养于尿液中。患者接受了 4 周的静脉抗生素治疗，随后转为口服抗生素治疗。在 18 个月的随访中，我们的患者的功能状态有了显著改善。
大多数研究支持炎症或创伤/机械性（假关节）病因是安德森病变最可能的原因。应调查可能的神经功能恶化，并显示出明显的脊柱不稳定。应检查后柱的完整性，并排除其他伴随病变。对于因后部骨折引起的不稳定病例，需要进行手术干预。脊柱外科医生应具备区分骨折与安德森病变的能力。在这种罕见的病例中，我们还强调脊柱外科医生应在安德森病变病例中获取术中培养物，以排除该实体感染来源的可能性较小，并/或排除受影响区域的可能继发性污染。
