Loss Of Lordosis Research Articles

Vertebral destruction at unfused segments in late ankylosing spondylitis.

ESTRUCTIVE changes at vertebral bodies have been described in ankylosing spondylitis. Usually they are seen at a fairly early stage of the disease and are apparently caused by rheumatoid granuloma (1–4, 6, 8). The association of destructive changes at the anterior articular surface of the vertebral bodies in late stages of this disease and at a segment where neither the spinous ligaments are completely ossified nor the apophyseal joints are fused has apparently not been reported. It appears that the vertebral destruction is caused by a pseudarthrosis. Motion of some degree is present and, because of solid fusion of the spine above and below the area of pseudarthrosis, great stress forces are being exerted on the anterior margins of the vertebral bodies, leading to absorption of bone and bone sclerosis. Patient S. S. (CASE I) clearly showed massive vertebral bone absorption, motion on flexion and extension, and open apophyseal joints by quite conventional x–ray methods (Fig. 1). His major complaint had been pain localized in the region of spine motion and destruction. Experience gained from this case led us to review some 80 cases of late ankylosing spondylitis, and 4 additional patients with similar but somewhat slighter vertebral destructive changes were found. The diagnosis of rheumatoid granuloma or infectious spondylitis had been considered in some of these patients. Upon reviewing the patients' case histories and clinical examination as well as recalling them for repeat x–ray examinations, we found that all had open apophyseal joints at the level of bone destruction and all complained of sharply localized pain in the region of the pseudarthrosis. Case Reports CASE I: This 58–year–old Caucasian male was seen for the first time in The Hospital for Special Surgery in November 1950 at the age of thirty–eight, with an 8–year history of back pain. Examination revealed marked limitation of motion in all segments of the spine and decrease in the chest expansion to 1 1/2 inches. The erythrocyte sedimentation rate was 70 mm in an hour, and the radiological examination showed fusion of the sacroiliac joints bilaterally, squaring of vertebral bodies of the lumbar spine, and partial subligamentous calcification. The patient received a trial of steroids for several months without benefit. He was also treated intermittently with phenylbutazone and physical therapy. Through the years marked deformities of the spine developed, with dorsal kyphosis, protrusion of the head and neck, and loss of lumbar lordosis. In 1960 the patient was hospitalized for the second time, complaining of a steadily progressive mid–back pain for the last eighteen months. Examination disclosed a point of marked tenderness at the D9 level. Examination disclosed a point of marked tenderness at the D9 level.