Ankylosing spondylitis

Case contributed by Dr Mohammad A. ElBeialy


Neck pain.

Patient Data

Age: 35 years
Gender: Male

  • straightened cervical curvature with some curve reversal.
  • calcification of the cervical discs evident by patchy bright T1 and T2 signal intensity with preserved their heights.
  • subchondral degenerative edematous marrow changes are noted at C7/D1 opposing vertebral end plates indicative of active Romanus lesion, with mild subchondral fatty degenerative changes of the other vertebrae.
  • mild fusion (ankylosis) of the facet joints.
  • relative squaring of the vertebral bodies with syndesmophytes of C7 and D1 as well as C2 and C3. Ossificaction of the anterior and posterior longitudinal ligaments is suggested.
  • no posterior disc bulge
  • normal cord and cervico-medullary junction
  • no intra-spinal or para-spinal soft tissue mass lesion

Active Romanus lesion ( shiny corner sign) of the anterosuperior corner of D1 vertebral body with subchondral low T1 and high T2 edematous signal. This lesion is very suggestive of ankylosing spondylitis.

  • straightened cervical curve with mild reversal.
  • fairly preserved dorsal kyphosis and lumbar lordosis.
  • diffuse disc calcification, most marked at the cervical and upper dorsal region.
  • diffuse ossification of the anterior and posterior vertebral longitudinal ligaments as well as the inter-spinous ligaments and facet joints of the cervical and upper dorsal spine as well as, but to much lesser extent, at mid dorsal and upper lumbar levels, together with bridging lateral syndesophyte at the dorso-lumbar region.
  • squaring of the examined vertebral bodies.
  • rather maintained disc spaces.
  • bilateral rather symmetrical sacroiliitis with fused both sacroiliac joints.

Case Discussion

The above described findings are typical of inflammatory seronegative spondyloarthopathy; ankylosing spondylitis with active Romanus lesion, disc calcifications, ossification of the anterior and posterior vertebral longitudinal ligaments, the inter-spinous ligaments and facet joints as well as bilateral symmetrical sacroiliitis. 

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