Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium‐ to long‐term outcomes

Abstract

The present study aimed to evaluate the clinical efficacy of Andersson lesion (AL) treatments and prognostic factors using medium-to long-term follow-up data and discuss the clinical characteristics and treatment of AL. Forty-eight consecutive AL cases at our center from June 2011 to March 2018 were retrospectively analyzed, including 13 cases treated conservatively and 35 treated surgically. Epidemiological characteristics, treatment modalities, clinical features and outcomes, and prognostic factors of the Japanese Orthopaedic Association (JOA) recovery rate were reviewed. Neurological functional recovery was evaluated by American Spinal Injury Association (ASIA) classification. Clinical efficacy was evaluated by JOA score, visual analog scale (VAS) score, and Cobb's angle. The mean overall follow-up duration was 44.5±18.5 months (range, 27-85 months). There were 36 male and 12 female patients, with a mean age of 49.4±13.1 years (range, 26-72 years). The most common lesion location was the thoracolumbar region, i.e., T10-L2 (n=33; 68.8%), followed by the thoracic (n=10) and lumbar (n=5) regions. Patients treated surgically showed significantly better JOA scores, VAS scores and Cobb's angles at the final follow-up than did patients treated conservatively (P<.05). Univariate and binary logistic regression analyses identified two prognostic factors of the JOA score recovery rate: treatment modality (OR=0.157; 95%CI, 0.028-0.89; P=.036) and bone fusion (OR=9.965; 95%CI, 2.052-48.387; P=.004). Conservative treatment and bone nonunion predict worse JOA score recovery. Surgery remains the optimal treatment for AL in ankylosing spondylitis patients, with better clinical efficacy demonstrated by medium-to long-term follow-up data.

Occult Andersson lesions in patients with ankylosing spondylitis: undetectable destructive lesions on plain radiographs

“…The possible reasons for misdiagnosis of ALs include unawareness of these lesions and their radiographic resemblance to other destructive lesions of the spine, such as infective spondylodiscitis, spinal tuberculosis, and tumors. [ 10 ] Merely using PR to detect ALs may account for the missed diagnosis of these lesions. A study by Kim et al [ 12 ] revealed that PR might underestimate the prevalence of ALs.…”

“…[ 9 ] The delayed diagnosis and management of ALs may contribute to the patients’ progressively deteriorating pain or kyphotic deformity, and may even cause neurologic deficits resulting from the overgrowth of fibrous or osseous tissue and subsequent spinal stenosis. [ 9 , 10 ]…”

“…[9] The delayed diagnosis and management of ALs may contribute to the patients' progressively deteriorating pain or kyphotic deformity, and may even cause neurologic deficits resulting from the overgrowth of fibrous or osseous tissue and subsequent spinal stenosis. [9,10] Plain radiography (PR) is the most widely used imaging technique for the diagnosis of ALs. The vertebral segments affected by ALs can be localized on plain radiographs with high convenience and relatively low cost.…”

“…Some ALs can be asymptomatic or present with back pain which is similar to the pain that may occur during the natural course of AS, which may only be detected on radiographic examination, many years later [9] . The delayed diagnosis and management of ALs may contribute to the patients’ progressively deteriorating pain or kyphotic deformity, and may even cause neurologic deficits resulting from the overgrowth of fibrous or osseous tissue and subsequent spinal stenosis [9,10] …”

Case Report: Identifying Andersson-Like Lesions in Diffuse Idiopathic Skeletal Hyperostosis

“…Nonetheless, persistent movement of AL segments will still impede the bony healing and union of erosive discovertebral fractures despite the employment of pharmacological and immobilized strategies, resulting in potential spinal cord injury. Therefore, surgical approaches are commonly used to reestablish spinal stability for late-stage ALs to alleviate ongoing back pain, correct kyphotic deformity, and recover neurologic status efficiently ( 26 ); such approaches include spinal canal decompression, transpedicular fixation, and vertebral fusion, which show optimal clinical alleviation with desirable efficacy in medium- to long-term follow-up ( 27 ). Likewise, it was suggested that internal spinal stabilization is a decent surgical approach for fractured lesions in DISH ( 28 , 29 ).…”