Ankylosing Spondylitis

Case History: A 52-year-old woman with low back pain

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Image 1: Inversion recovery midline sagittal; T2 midline sagittal; T1 midline sagittal

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Image 2: T2 axial at the 4 level; T2 coronal

Findings: Sagittal sequences demonstrate syndesmophyte formation along the anterior vertebral column. There is also increased signal in the lower intervertebral discs on the T1 and T2 sequences which in this situation corresponds to calcification of the disc. Coronal sequence demonstrates fusion of the sacroiliac joints and the axial sequence demonstrates dural ectasia and thecal diverticula.

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Image 3: T2 midline sagittal; T1 midline sagittal

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Image 4: T2 axial at the 4 level; T2 coronal

Diagnosis: Ankylosing spondylitis

Discussion: Seronegative arthropathy that produces syndesmophytes (ossification of the annulus fibrosus) that start at the thoracolumbar junction and extend cranially and caudally, sacroilitis with eventual fusion, and enthesopathic change. In cases of marked disease and later in the time course dural ectasia may become manifest with associated cauda equina syndrome.

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Image 5: Supplemental radiographs radiographs demonstrate syndesmophyte formation of the cervical spine as well as osseous bridging of the facet joints. Single view of the left knee demonstrates enthesopathic change along the course of the MCL.

  Resources:  
• Resnick and Kransdorf. Bone and Joint Imaging. 2005.
• http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17332972&itool=iconabstr&query_hl=3&itool=pubmed_docsum
• http://www.rheumatology.org/public/factsheets/as.asp

Case courtesy Hospital for Special Surgery. ©2013 Hospital for Special Surgery. Click here for more Case Studies from HSS.