“ SPINE X-RAY • Sclerosis at the edge of the discovertebral joints (‘shiny corner’) and erosion (‘Romanus lesions’) are early signs. • S...
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SPINE X-RAY
• Sclerosis at the edge of the discovertebral joints (‘shiny corner’) and erosion (‘Romanus lesions’) are early signs.
• Squared vertebral bodies (more obvious in the lumbar spine).
• Progressive growth of syndesmophytes (ossification of the outer fibres of the annulus fibrosus)— these eventually bridge the disc and cause ankylosis. As more bone forms, the spine develops a smooth, undulating contour ‘bamboo spine’.
• Prominent thoracic kyphosis and limited lumbar lordosis.
• Erosion of the endplate.
• Facet joint ankyloses.
• Look for three-column fractures—the ankylosed spine is very susceptible to fracture.
• Signs: ‘dagger’ sign (ossification of the supraspinous and interspinous ligaments on frontal radiographs) and ‘trolley track’ (denotes three vertically orientated dense lines corresponding to ossified supraspinous and interspinous ligaments.
Ankylosing spondylitis. Frontal lumbar spine radiograph demonstrating the dagger sign (flowing ossification of the supraspinous and interspinous ligaments in a single dense line [white arrows]) and the trolley track sign (ossification of the apophyseal joints [red arrows] as well as the supraspinous and interspinous ligaments).
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