Cervical spine osteolysis in a case of undifferentiated spondyloarthropathy with features mimicking neoplasm or infection.
METHODS
Case Report.


OBJECTIVE
To present a case of undifferentiated spondyloarthropathy with sternocostoclavicular arthro-osteitis and osteolyis of cervical body requiring surgical reconstruction of the spine and describing the findings which resembled multiple metastases or infection.


BACKGROUND
Sternocostoclavicular arthro-osteitis is not infrequent in Japan. It has been reported in patients with seronegative spondyloarthropathies as psoriatic arthropathy or its variant, palmoplantar pustulosis. Cervical spine involvement in the seronegative spondyloarthropathy is usually in the form of syndesmophytes, subluxations, or facet erosions/ fusions. To the best of our knowledge, this is the first report on severe osteolytic cervical spondylitis associating anterior chest wall disease, to the extent that surgical reconstruction is needed.


METHODS
A 64 year-old woman presented with neck pain. Cervical spine imaging revealed osteolysis and crumbling of C5 vertebral body. Computed tomography of the thorax showed multiple erosions of the anterior chest wall. Multiple hot spots were detected by bone scan. Biopsies were obtained to exclude neoplasm and infection. Surgical reconstruction via combined anterior-posterior approach was performed to achieve solid spine arthrodesis.


RESULTS
Neoplasm and infection were excluded. Careful reassessment alerted to the diagnosis of undifferentiated spondyloarthropathy. Solid arthrodesis and pain relief could be obtained by surgery together with medical control of the disease.
El Zahlawy
Hany
H
Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan. hzahlawy@hotmail.com
Yukawa
Yasutsugu
Y
Ito
Keigo
K
Nakashima
Hiroaki
H
Machino
Masaaki
M
Horie
Yumiko
Y
Kato
Fumihiko
F
D001174:Arthrodesis; D044466:Asian People; D001859:Bone Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007564:Japan; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010000:Osteitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D010014:Osteolysis / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D010019:Osteomyelitis / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D019651:Plastic Surgery Procedures / Q000379:methods; D013123:Spinal Fusion; D025242:Spondylarthropathies / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome