Ankylosing spondylitis

Case contributed by Dr Derek Smith

Presentation

Worsening lumbar back pain over a month, mainly at night. Midline tenderness over L3/4. Previously investigated for similar back pain.

Patient Data

Age: 40 years
Gender: Female
MRI

Transitional lumbosacral anatomy, with lumbarization of S1.

Anterior corner signal abnormalities in the T9-L1 vertebral bodies. Small L3 benign hemangioma.

Extensive signal change at L4 and L5, extending into the L5 pedicles bilaterally. L5 limbus vertebra as on prior radiograph (below) with interval development of a L5 superior endplate Schmorl node. No paravertebral soft tissue abnormality.

No disc bulge, herniation or neural compression.

Partly imaged sacroiliac joints with bilateral signal change mainly corresponding to sclerosis with fatty marrow change in the sacral ala.

10 years earlier

X-ray

Transitional anatomy.

L5 limbus vertebra.

Case Discussion

A constellation of imaging findings compatible with ankylosing spondylitis including shiny corner / Romanus lesions, sacroiliitis and florid discovertebral signal change at L4/5 compatible with an Andersson lesion.

The patient's serology is positive for HLA B27.

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