Ankylosing spondylitis x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


A clinical examination and x-rays of the spine, which show characteristic spinal changes such as sacroiliitis, are the major diagnostic tools for ankylosing spondylitis. The findings on an x-ray that are consistent with a diagnosis of ankylosing spondilitis are the presence of subchondral erosions, sclerosis, proliferation on the iliac side of SI joints, and squaring of the vertebral body.

X Ray

Ankylosing spondylitis (Morbus Bechterew)
  • Indistinct joints
  • Joints widen before narrow
  • Subchondral erosions, sclerosis, and proliferation on iliac side of SI joints
  • At endstage, sacroiliac joint may be a thin line or not visible
  • In the spine, early spondylitis is characterized by small erosions at the corners of vertebral bodies with reactive sclerosis
  • Squaring of the vertebral body
  • Syndesmophyte formation, with bridging of the corners of one vertebra to another
  • Ossification of paravertebral connective tissue fibers, including posterior interspinous ligaments as well as linking of spinous processes leads to an appearance of a solid midline vertical dense line on AP projection
  • May see associated pseudoarthroses (discovertebral destruction with adjacent sclerosis) and enthesopathic changes (ill-defined erosions with adjacent sclerosis at sites of ligamentous and tendenous attachments)
  • Hip involvement is generally bilateral and symmetric, with uniform joint space narrowing, axial migration of the femoral head, and a collar of osteophytes at the femoral head-neck junction
  • Knees demonstrate uniform joint space narrowing with bony proliferation
  • Hands are generally involved asymmetrically, with smaller, shallower erosions and marginal periostitis.
  • Radiographs of the lungs may demonstrate progressive fibrosis and bullous changes at the apices. These lesions may resemble TB infection and bullae may become infected.

A drawback of X-ray diagnosis is that signs and symptoms of AS have usually been established as long as 8-10 years prior to X-ray evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced.