Kumar Akshay J, Sathiyaseelan Naveen, Vinodh J Benjamin, Vignesh Arun, Rathi Nitesh Kumar
Department of Orthopaedics, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
J Orthop Case Rep. 2025 Jan;15(1):21-25. doi: 10.13107/jocr.2025.v15.i01.5110.
Ankylosing spondylitis (AS) is a chronic inflammatory disorder that primarily affects the spine and sacroiliac joints, leading to pain, stiffness, and progressive thoracolumbar kyphotic deformity. A key complication in advanced AS is the development of Andersson lesions (AL), degenerative vertebral lesions resulting from the disease's progression. These lesions can cause significant mechanical pain, often mistaken for the chronic discomfort associated with AS. The exact cause of AL remains unclear, with hypotheses ranging from spinal stress fractures to delays in the ankylosing process. Understanding AL's pathophysiology is essential for timely diagnosis and effective management.
A 52-year-old male presented with a 20-year history of diffuse abdominal pain, later developing insidious lower back pain over the past 2 months. The pain was aggravated by walking and prolonged standing. Physical examination revealed tenderness in the D11 region of the spine, with limited chest expansion and positive findings on the modified Schober's test. Radiographic studies showed irregularities and erosions at the D11-D12 vertebral levels, and magnetic resonance imaging confirmed the presence of an AL associated with asymmetrical bilateral sacroiliitis. The patient tested positive for human leukocyte antigen-B27, supporting a diagnosis of AS with an AL. Medical management, including methotrexate, sulfasalazine, non-steroidal anti-inflammatory drugs, and corticosteroids, led to significant pain reduction and improved mobility. The patient's condition remained stable with continued treatment over a 2-year follow-up period.
AL s are chronic, often overlooked complications of AS that can lead to spinal instability and neurological deficits if untreated. Early recognition and management are critical to preventing progressive kyphotic deformities and associated complications. While conservative treatment remains the cornerstone for managing AL, surgical intervention may be required in cases of severe pain, deformity, or neurological involvement. Understanding AL's presentation and treatment options is vital for improving patient outcomes in AS.
强直性脊柱炎（AS）是一种慢性炎症性疾病，主要影响脊柱和骶髂关节，导致疼痛、僵硬以及进行性胸腰椎后凸畸形。晚期AS的一个关键并发症是安德森病变（AL）的出现，这是由于疾病进展导致的退行性椎体病变。这些病变可引起严重的机械性疼痛，常被误诊为与AS相关的慢性不适。AL的确切病因尚不清楚，假说范围从脊柱应力性骨折到强直性过程的延迟。了解AL的病理生理学对于及时诊断和有效管理至关重要。
一名52岁男性，有20年弥漫性腹痛病史，在过去2个月逐渐出现隐匿性下背痛。行走和长时间站立会加重疼痛。体格检查发现脊柱第11胸椎区域有压痛，胸廓扩张受限，改良Schober试验结果阳性。影像学检查显示第11 - 12胸椎水平有不规则和侵蚀，磁共振成像证实存在与不对称双侧骶髂关节炎相关的AL。该患者人类白细胞抗原 - B27检测呈阳性，支持AS伴AL的诊断。包括甲氨蝶呤、柳氮磺胺吡啶、非甾体抗炎药和皮质类固醇在内的药物治疗使疼痛显著减轻，活动能力得到改善。在2年的随访期内，持续治疗使患者病情保持稳定。
AL是AS的慢性且常被忽视的并发症，如果不治疗可导致脊柱不稳定和神经功能缺损。早期识别和管理对于预防进行性后凸畸形及相关并发症至关重要。虽然保守治疗仍然是管理AL的基石，但在严重疼痛、畸形或神经受累的情况下可能需要手术干预。了解AL的表现和治疗选择对于改善AS患者的预后至关重要。
