Dr. Ajay / Dr. Sudha K Das,Resident / Asst Professor, JSSMC - Mysore

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Greek origin: “stiff spine” Ankylos - stiff; Spondylos - spine.

Autoimmune: 90% - HLA-B27

Also known as: Marie strumpell disease Bekhterev’s disease

SI joint related: Postage stamp / Saw blade / Rosary bead / Star sign.

Romanus lesion.

Shiny corner /Ivory corner sign.

Dagger sign.

Trolley track sign.

Andersson lesion.

Bamboo spine.

Joint edges have a serrated appearance due to tiny succinct erosions – akin to perforated edge of a postage stamp.

Start on the iliac side (due to the thinner cartilage) and then progress to the sacral side.

Small erosions lined up one behind another at corresponding sites of the ilium and the sacrum resemble a string of beads or rosary.

String of beads..

Ossification or erosion of the ligamentous attachments to the iliac crest/ischial tuberosity.

Ossification of capsuloligamentous structures at the superior part of the sacroiliac joint (arrows).

Also seen “trolley track” & “dagger sign” (arrow heads).

Parts of the articular contour that remain visible with the advent of bony ankylosis.

Also known as ghost joint.

Note faint “star sign” (depicted by arrows).

Hall mark of AS when both the SI joints are involved.

Triad of sacroiliac destruction sclerosis & discrete ankylosis

A triangular or quadrant, sharply marginated, corner abnormality of the discovertebral junction unassociated with endplate erosion, osteophytes, or Schmorl's node.

Described by Romanus & Yden.

Anterior or posterior edges of vertebral end-plates.

Inactive disease: fatty replacement followed by end-plate sclerosis. Hypointense on T1 and hyperintense on

STIR – Active lesion

Inactive romanus lesion.

Superior end-plate sclerosis, shiny corner.

Caused by a combination of corner erosions with resorption at the enthesis.

Best seen in the lumbar region, loss of anterior vertebral concavity and straightening of the anterior vertebral margin. Note the normal

anterior vertebral concavity

Posterior interspinous ligament ossification.

Solid, midline vertical density simulation a dagger.

Preceded by the formation of syndesmophytes.

Three lines:

Central vertical line: ossification of supraspinous and interspinous ligaments

Two lateral vertical lines: ossification of the apophyseal joint capsules

Complete fusion of all of the vertebral bodies.

Sequel to florid anterior spondylitis & diskitis resulting in bony ankylosis.

Fusion is secondary to syndesmophytes and resembles a bamboo stalk.

Large erosion on the lateral aspect of the humeral head, reminiscent of a hatchet.

Lack of osteoporosis & presence of bony proliferation at site of erosion differentiates this from RA.

Three types of spondylodiscitis:

Type 1: Central portion of the discovertebral junction that is covered by cartilage.

Type 2: Peripheral portion of discovertebral junction not covered by cartilaginous endplate.

Type 3: involves both the peripheral and central portions.

Type 1 Type 3

Carrot stick fracture with Type 3 Andersson

Appearance of intervertebral disc with alternating concentric hyperintense and hypointense bands.

Carrot stick fracture: Diskovertebral lesion with transverse fracture, results in spinal pseudoarthrosis.

Transdiskal fracture involving facet joints.

Some are named and some are not, To some with ease and to some a bane,

Please thou thyself with it my friend,For it pleases the one who grades thee in the end.

Do mail us back at (jssmcrad@gmail.com) - if you come across more signs that can be added to this “sign soup”.