Abstract
Spondylarthropathies are a heterogeneous group of chronic inflammatory diseases affecting the spine and sacroiliac joints. They display a negative serostatus for rheumatoid factor, thus termed seronegative spondylarthritides, but are strongly associated with HLA-B27. Spondylarthropathies can be classified in ankylosing spondylitis (Bechterew disease), the most frequent seronegative spondylarthropathy, or as psoriatic spondylarthritis, reactive arthritis (formerly termed Reiter syndrome), enteropathic spondylarthritis (associated with inflammatory bowel disease), and undifferentiated spondylarthritis. As each category does not represent a distinctive entity, clinical, laboratory, and also imaging findings may overlap, clinical neuroradiology may not lead to a definitive diagnosis, but to certain imaging patterns, and possible differential diagnoses.
Noninflammatory conditions with ossifications of the paravertebral ligaments may result in ankylosis of the spine as well. The most frequent entities of noninflammatory ankylosis are diffuse idiopathic skeletal hyperostosis (DISH), and ossification of the posterior longitudinal ligament (OPLL), but exclusive ossification of the flava ligaments (OFL) may occur as well.
Spondylodiscitis is an infectious disorder of the spine found mostly in elderly, immobile, and immune suppressed patients, in particular after trauma or surgery. As clinical symptoms and laboratory tests are unspecific, imaging plays a pivotal role in its diagnosis. In certain cases, image-guided acquisition of tissue for microbiological tests may be useful for diagnosis, targeted antibiotic therapy, or evaluation of suspicious imaging findings. In early stages of the disease, radiography and CT may be normal, or at least unspecific, in case of preexisting degenerative conditions. MRI is the radiological technique of choice; as it shows pathological findings even in early stages of the disease and potential involvement of the paraspinal tissue.
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Abbreviations
- CRP:
-
C-reactive protein
- DISH:
-
Diffuse idiopathic skeletal hyperostosis
- DMARD:
-
Disease modifying anti-rheumatic drug
- ESR:
-
Erythrocyte sedimentation rate
- HLA:
-
Human leukocyte antigen
- NSAID:
-
Non-steroidal anti-inflammatory drug
- OFL:
-
Ossification of flava ligament
- OPLL:
-
Ossification of the posterior longitudinal ligament
- STIR:
-
Short tau inversion recovery
- TNF:
-
Tumor necrosis factor
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Further Readings
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Wolf, M., Weber, MA. (2019). Inflammatory and Infectious Disorders of the Spine. In: Barkhof, F., Jager, R., Thurnher, M., Rovira Cañellas, A. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-61423-6_80-1
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