[Discopathies after fractures and destructive vertebral lesions during rheumatismal pelvispondylitis]

In three cases of rheumatic spondylitis, fracture across the disc of an ankylosed spinal segment (C5-C6, D7-D8, and D12-L1 respectively) resulted in rapid development of a discopathy with destruction of the adjacent vertebral bodies. In one of these cases, surgical exposure of the focus permitted anatomical study of the lesion; the changes that had developed after the fracture were inflammatory in appearance, which at first suggested infection by non-specific micro-organisms, an assumption that was rapidly abandoned. This misleading histological appearance largely explains why these destructive discopathies in spondylitis have long been regarded as a consequence of the rheumatic process itself. A review is presented of the arguments which suggest that they have, in fact, a mechanical pathogenesis, often determined by a fracture. From this it may be concluded that the treatment of choice is temporary immobilization in moderate cases and surgery with transplantation in complicated or unstable cases.