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Andersson Lesions and Ankylosing Spondylitis

Posted on December 28, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kristopher Bunting, M.D.

Ankylosing spondylitis (AS) is the advanced form of axial spondyloarthritis, a type of autoimmune arthritis that affects the spine and hip bones. Andersson lesions are an unusual type of damage to the spine caused by AS that destroys weight-bearing intervertebral joints and causes spinal fractures.

What Are Andersson Lesions?

Andersson lesions are a type of damage to the spine seen in some people with advanced AS (also called radiographic axial spondyloarthritis). Andersson lesions have been called many different names, including discovertebral lesions and spondylodiscitis.

It is not known how common Andersson lesions are — various studies have reported their prevalence as anywhere from 1.5 percent to 28 percent in people with AS.

Andersson lesions are caused by damage to the weight-bearing intervertebral joints of the spine. These joints are made up of vertebral bodies (the large, thick part of spinal bones) and the intervertebral disc (the rubbery soft tissue that acts as a cushion between vertebral bodies). Ligaments hold the joint together, connecting the vertebral bodies and anchoring the intervertebral disc in place.

The hallmark of AS is the abnormal growth of bone that results in ankylosis, or the fusion of the sacroiliac joints (which connect the hips and spine) and vertebrae in the spine. AS causes bone to grow between vertebrae, fusing them together. Between vertebral bodies, bone grows and connects vertebrae together around the edge of the intervertebral disc, locking the disc in place.

Andersson lesions occur when there is destruction of the bone above or below a disc. The lesions may also involve destruction of the disc itself. This destruction can lead to back pain and neurological symptoms caused by pressure on the spinal cord and the nerves that branch off of the spinal cord.

The damage can also lead to spinal pseudoarthrosis, a “break” in ankylosed spine that has been fused together by AS. In addition to pain, pseudoarthrosis can cause abnormal mobility and instability in the spine.

Andersson lesions can occur anywhere in the spine, including the cervical spine in the neck or the thoracolumbar spine in the chest and lower back. Destructive lesions can occur at a single intervertebral joint or affect multiple joints in the spine. Sometimes, joint destruction leads to exaggerated kyphosis (forward curvature of the thoracic spine) or lordosis (backward curvature of the lumbar spine).

RA or spondylitis? Similar symptoms, different conditions. Learn more.

What Are Symptoms of Andersson Lesions?

Andersson lesions are sometimes asymptomatic, but the usual symptoms include localized back pain and spine instability. Pressure on the spinal cord or spinal nerves can sometimes cause neurological symptoms (symptoms that affect the nerves) such as:

  • Pain
  • Numbness
  • Tingling
  • Weakness in the lower body

Depending on where the lesions occur, they can also cause autonomic dysfunction. The autonomic nervous system controls blood pressure, bowel function, bladder function, sexual function, and other involuntary bodily functions. Dysfunction of the autonomic system can be life-threatening in rare cases.

How Are Andersson Lesions Diagnosed?

Andersson lesions are diagnosed using imaging techniques such as X-rays, computed tomography scans, and magnetic resonance imaging (MRI).

X-rays of the spine can show abnormalities in the vertebrae that can include:

  • Sclerosis (thickening) of the edge of the vertebrae
  • Erosion or destruction of the center of the vertebral body
  • Narrowing of the disc space between vertebrae
  • Fractures or pseudoarthrosis at the intervertebral joint

Computed tomography scans can also be used to create detailed images of the spine. An MRI scan can be used to see the soft tissue of the spine and identify inflammation in the vertebrae.

What Causes Andersson Lesions?

There is some dispute over the etiology (underlying causes) of Andersson lesions. Recent research has grouped Andersson lesions into inflammatory and noninflammatory lesions. It is believed that Andersson lesions begin due to inflammation in the intervertebral joints and later progress to noninflammatory lesions.

Inflammation

Inflammation can cause hardening of the outside of the bone. Early on, this inflammation does not cause any changes that can be seen on X-rays, but the inflammatory lesions can be seen using an MRI.

Eventually, inflammation leads to degeneration of the vertebrae, hollowing out the flat parts of the bone that support the body’s weight. These changes can be seen on an X-ray. Over time, discitis (inflammation) causes the disc to degenerate and eventually disappear.

Osteoporosis

Osteoporosis (loss of bone mass) seen with spondylitis also contributes to Andersson lesions by making bone tissue weaker and more brittle. Ultimately, the lesions result in weak and brittle bone in the vertebrae as well as the bony growths that fuse the vertebrae. This brittle bone is very prone to fractures and stress fractures (chronic microfractures).

Trauma

Noninflammatory lesions — which include pseudoarthrosis (spinal fracture) and may involve kyphosis (abnormal curvature of the spine) — may be caused by trauma or stress fractures.

How Are Andersson Lesions Treated?

Treatment for Andersson lesions depends on the severity of symptoms and whether the lesions are inflammatory or more advanced.

Inflammatory lesions can be treated with medications, such as nonsteroidal anti-inflammatory drugs, as well as rest, braces, and physical therapy.

Severe symptoms, including neurological symptoms, generally require surgery. Surgical treatment options for Andersson lesions are the same spinal surgeries used to treat AS, such as:

  • Decompression (laminectomy) to remove a portion of a vertebra to relieve pressure on the spinal cord and nerves
  • Spinal fusion to join vertebrae together using metal hardware and sometimes bone grafts
  • Osteotomy to remove portions of damaged vertebrae, which may be performed along with spinal fusion

Andersson lesions generally respond well to treatment. Studies have shown that spinal fusion surgery is very effective for improving pain and other symptoms.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis. On MySpondylitisTeam, more than 85,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Do you have Andersson lesions? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.

References
  1. Ankylosing Spondylitis — Mayo Clinic
  2. Spondyloarthritis — American College of Rheumatology
  3. Discovertebral (Andersson) Lesions of the Spine in Ankylosing Spondylitis Revisited — Clinical Rheumatology
  4. Ankylosing Spondylitis (AS) — Cleveland Clinic
  5. Pseudoarthrosis in Ankylosing Spondylitis — Case Studies in Diagnostic Imaging
  6. Autonomic Neuropathy or Autonomic Dysfunction (Syncope): Information and Instructions — Cleveland Clinic
  7. Discovertebral (Andersson) Lesion of the Ankylosing Spondylitis, A Cause of Autonomic Dysreflexia in Spinal Cord Injury — Spinal Cord Series and Cases
  8. Computed Tomography (CT) Scan — Johns Hopkins Medicine
  9. Magnetic Resonance Imaging (MRI) — Johns Hopkins Medicine
  10. Andersson Lesion: Are We Misdiagnosing It? A Retrospective Study of Clinico-Radiological Features and Outcome of Short Segment Fixation — European Spine Journal
  11. Etiology of Pseudarthrosis in Ankylosing Spondylitis: What Is the Main Cause? — The Journal of Rheumatology
  12. The Andersson Lesion in Ankylosing Spondylitis: Distinguishing Between the Inflammatory and Traumatic Subtypes — The Journal of Bone and Joint Surgery
  13. Occult Andersson Lesions in Patients With Ankylosing Spondylitis: Undetectable Destructive Lesions on Plain Radiographs — Chinese Medical Journal
  14. Osteoporosis — Mayo Clinic
  15. Stress Fractures — Mayo Clinic
  16. Complications of the Spine in Ankylosing Spondylitis With a Focus on Deformity Correction — Journal of Neurosurgery
  17. Surgery for Ankylosing Spondylitis — SpineUniverse
  18. Ankylosing Spondylitis Surgery — Arthritis-Health
  19. Laminectomy — Johns Hopkins Medicine
  20. Posterior Wedge Osteotomy and Debridement for Andersson Lesion With Severe Kyphosis in Ankylosing Spondylitis — Journal of Orthopaedic Surgery and Research
  21. Management of Andersson Lesion in Ankylosing Spondylitis Using the Posterior-Only Approach: A Case Series of 18 Patients — Asian Spine Journal
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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