Season 9 Case 10
Hx: trauma survey exam. Fall, pain
Dx? Anything else you may want to consider given the history?
Answer: Ankylosing Spondylitis
We have:
-fused SI joints
-fused pubic symphysis
- interspinous ligament ossification = "dagger spine"
-fused Lspine?
** Look for spine fx!
Ankylosing Spondylitis:
-seronegative spondyloarthropathy (neg Rheum factor) that yields fusion of the spine, SI jts, pubic symphsysis, and sometimes other jts
-assoc w HLA B27 gene
-M>F
-usually presents 3rd-4th decade
-trt: NSAIDS, motion/exercise, TNF-alpha blockers
Ankylosing Spondylitis Imaging
-sacroiliitis is bilateral & symmentric
-Romanus lesion - small vert corner erosion w sclerosis (shiny corner sign) -squaring of vert -"bamboo spine"
-parallel paravert syndesmophytes -"dagger spine" - interspinous lig ossif and so much more!
Ank Spon Complications:
Fractures! - although fused, bones are brittle and don't respond well to extreme motion/trauma. This yields "chalk stick" fx (snaps straight through). Can be subtle so look closely on CT.
Pseudoarthroses are common after fractures (example below).
