Internal Fixation for Stress Fractures of the Ankylosed Spine

Marsh, C. H.

doi:10.1177/014107688507800506

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…It has been postulated that AL might be exceptional extensions of this inflammatory process [ 4 , 13 , 23 , 24 ]. Marsh even documented a symptomatic Romanus lesion rontgenologically, which progressed to a complete destructive lesion within 2 years [ 25 ]. However, many authors disagree since the Romanus lesion is an enthesitis limited to the junction of the anterior longitudinal ligament and annulus fibrosus [ 16 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited

et al. 2009

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A well-known complication in patients with ankylosing spondylitis (AS) is the development of localised vertebral or discovertebral lesions of the spine, which was first described by Andersson in 1937. Since then, many different terms are used in literature to refer to these localised lesions of the spine, including the eponym ‘Andersson lesion’ (AL). The use of different terms reflects an ongoing debate on the exact aetiology of the AL. In the current study, we performed an extensive review of the literature in order to align communication on aetiology, diagnosis and management between treating physicians. AL may result from inflammation or (stress-) fractures of the complete ankylosed spine. There is no evidence for an infectious origin. Regardless of the exact aetiology, a final common pathway exists, in which mechanical stresses prevent the lesion from fusion and provoke the development of pseudarthrosis. The diagnosis of AL is established on conventional radiography, but computed tomography and magnetic resonance imaging both provide additional information. There is no indication for a diagnostic biopsy. Surgical instrumentation and fusion is considered the principle management in symptomatic AL that fails to resolve from a conservative treatment. We advise to use the term Andersson lesion for these spinal lesions in patients with AS.

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Section: Discussionmentioning

confidence: 99%

Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited

et al. 2009

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“…Healing in such lesions was described in 1985 by Marsh [12]; he described that one lesion healed with kyphosis spontaneously, while two lesions needed posterior interspinous fixation without bone grafting.…”

Section: Discussionmentioning

confidence: 99%

“…Poor muscle mass and skin condition, osteoporotic skeleton, dural adhesions, extensive blood loss, associated neurological deficit, and problems in wound healing can complicate the intra-operative and the postoperative course. Extensive dural adhesions to the calcified ligamentum flavum are commonly observed; therefore, posterior exposure can result in dural tears and defects [12]. It has now been well documented that perioperative morbidity is lowest in the posterior-only approach to the spine than that in the anterior and posterior as well as the anterior only approach [27].…”

Section: Discussionmentioning

confidence: 99%

Management of Andersson Lesion in Ankylosing Spondylitis Using the Posterior-Only Approach: A Case Series of 18 Patients

et al. 2018

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Study DesignThis retrospective study was conducted including 18 patients who underwent posterior-only stabilization and fusion procedure for pseudoarthrosis in the ankylosed spine from October 2007 to May 2015.PurposeThis study aimed to describe the treatment outcomes in 18 patients with Andersson lesion (AL) who were managed using the posterior-only approach.Literature ReviewAL is an unstable, localized, vertebral, or discovertebral lesion of the spine. It is observed in patients with ankylosing spondylitis. The exact etiology of this disorder remains unclear, and the treatment guidelines are not clearly described.MethodsWe analyzed 18 patients with AL who were treated with posterior long segment spinal fusion without any anterior interbody grafting or posterior osteotomy. Pre- and postoperative radiography, computed tomography, and recent follow-up images were examined. The pre- and postoperative Visual Analog Scale score and the Oswestry Disability Index score were evaluated for all patients. Whiteclouds’ outcome analysis criteria were applied at the follow-up. Moreover, at study completion, patient feedback was collected; all the patients were asked to provide their opinion regarding the surgery and were asked whether they would recommend this procedure to other patients and them self undergo the same procedure again if required.ResultsThe most common site was the thoracolumbar junction. The symptom duration ranged from 1 month to 10 years preoperatively. Most patients experienced fusion by the end of 1 year, and the fusion mass could be observed as early as 4 months. Pseudoarthrosis void of up to 2.5 cm was noted to be healed in subsequent imaging. In addition, clinically, the patients reported good symptomatic relief. No patient required revision surgery. Whiteclouds’ outcome analysis score at the latest follow-up revealed good-to-excellent outcomes in all patients.ConclusionsALs can be treated using the posterior-only approach with long segment fixation and posterior spinal fusion. This is a safe, simple, and quick procedure that prevents the morbidity of anterior surgery.

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“…Lately, there have been reports of stress fractures developing in conjunction with such systemic structural skeletal diseases as osteoporosis, pyrophosphatic arthropathy, arthrosis, and rheumatoid spondylitis, as well as following the implantation of hip-joint endoprostheses [4,8,[11][12][13][14].…”

mentioning

confidence: 99%

“…For example, stress fractures of the radius, patella, vertebrae, and other infrequent localizations [3,5,8] have been described. The increasing number of diagnosed stress fractures is due not only to the greater number of people who participate in physical activities, Offprint requests to: B.Posinkovid, Hedimovideva ul.…”

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confidence: 99%

Bilateral pseudarthrosis of the femur after stress fracture

Posinković

Pavlovic

1990

Arch Orthop Trauma Surg

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Stress fractures of the diaphysis of the femur are very rare, particularly bilateral ones. We describe here a woman patient with bilateral pseudoarthrosis of the femoral diaphysis which was the result of a stress fracture. The case is a rarity because the in question is of a dwarfism stature with great deformation of the lower extremities due to rickets. The patient has been closely examined for over 30 years. Our own explanation for the beginnings of stress fracture as well as for the pseudarthrosis development are given.

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Internal Fixation for Stress Fractures of the Ankylosed Spine

Cited by 6 publications

References 3 publications

Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited

Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited

Management of Andersson Lesion in Ankylosing Spondylitis Using the Posterior-Only Approach: A Case Series of 18 Patients

Bilateral pseudarthrosis of the femur after stress fracture

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