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Quiescent Andersson Lesion Simplifies Deformity Correction: A Case Report.

Arvind G Kulkarni1,2, Goparaju V N R Praveen1,2

  • 1Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, India.

JBJS Case Connector
|September 24, 2021
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Summary
This summary is machine-generated.

This case study highlights how a suspicious Andersson lesion (AL) in ankylosing spondylitis can unexpectedly change during surgery. Intraoperative reassessment led to a successful fusion without osteotomy.

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Area of Science:

  • Spine surgery
  • Rheumatology
  • Radiology

Background:

  • Ankylosing spondylitis (AS) can lead to spinal deformities like sagittal imbalance.
  • Andersson lesions (AL) are inflammatory lesions at the discovertebral junction, often seen in AS.
  • Preoperative imaging may not always reveal the dynamic instability of ALs.

Observation:

  • A patient with AS and sagittal imbalance presented with a suspicious D12-L1 Andersson lesion (AL).
  • Initial imaging (radiographs and MRI) suggested no significant mobility at the AL segment.
  • A planned L2 pedicle subtraction osteotomy was reconsidered due to intraoperative findings.

Findings:

  • The Andersson lesion (AL) significantly destabilized during intraoperative positioning, contrary to preoperative assessments.
  • The surgical plan was adapted intraoperatively, shifting from osteotomy to interbody fusion.
  • Correction was successfully achieved using a cantilever technique without performing the planned osteotomy.

Implications:

  • This case underscores the potential for dynamic instability in Andersson lesions (ALs) despite quiescent imaging findings.
  • Intraoperative reassessment and flexible surgical planning are crucial for managing unexpected changes in spinal instability.
  • Successful management of complex spinal deformities in AS can be achieved through adaptive surgical strategies.