Andersson-like lesion in diffuse idiopathic skeletal hyperostosis; a rare diagnostic and therapeutic challenge

Andersson-like lesions (ALL) in diffuse idiopathic skeletal hyperostosis (DISH) are rare and often underrecognized entities that can mimic infective spondylodiscitis or inflammatory lesions such as Andersson lesion (AL) in ankylosing spondylitis (AS). Timely differentiation is crucial to avoid misdiagnosis and inappropriate treatment.

We report a 57-year-old diabetic male presenting with progressive cervical myelopathy and radiological findings suggestive of a discovertebral lesion at C6-C7 in the setting of DISH. Despite initial suspicion of infection, negative inflammatory markers and sterile intraoperative cultures, along with imaging and intraoperative findings, supported a diagnosis of ALL. The patient underwent staged surgical management with posterior decompression and fusion followed by anterior cervical discectomy and fusion, resulting in significant neurological and functional improvement.

This case highlights the importance of recognizing ALL in DISH as a mechanical, non-infective lesion that can lead to spinal instability and neurological compromise. Differentiation from infectious or inflammatory pathologies is essential to guide timely surgical intervention and avoid adverse outcomes.