A destructive discovertebral lesion: septic discitis, ankylosing spondylitis, or rheumatoid arthritis?
A 41-year-old male with a 20-year history of classical ankylosing spondylitis, psoriasis and seropositive, nodular erosive rheumatoid arthritis presented with a 12-month history of thoracolumbar junction pain following minor trauma. A pseudoarthrosis was noted at the T11/12 level on plain radiographs and tomograms. A gallium scan showed no increased isotope uptake, and a computed tomogram (CT) revealed no evidence of a paraspinal collection. Conservative management including cast immobilisation and local radiotherapy was ineffective, and spinal fusion was required. A typical Andersson lesion was found at operation. The diagnostic and therapeutic problems of such discovertebral lesions are discussed.
Arnold
M H
MH
Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital of Sydney, St Leonards, New South Wales, Australia.
Brooks
P M
PM
Ryan
M
M
Francis
H
H
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis*; D001416:Back Pain / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D015299:Discitis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007239:Infections; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D013123:Spinal Fusion; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D014054:Tomography; D014057:Tomography, X-Ray Computed