PURPOSE OF THE STUDY: The authors describe the surgical treatment of three cases of vertebral pseudarthrosis in two patients suffering from rheumatoid spondylitis for an average of 20 years. MATERIAL: Two pseudarthrosis involved the thoracic level (T9-T10 and T10-T11), after an insignificant trauma. In the other case, the lesion was a secondary localization (L5-S1) arising spontaneously two years after the treatment of a T10-T11 lesion. Initial conservative treatment was unsuccessful in all three cases. Anterior surgery was performed in all three cases. In two out of the three, posterior surgery was associated with the anterior approach. RESULTS: After surgery, the three lesions healed. DISCUSSION: Extensive discovertebral lesions during the course of rheumatoid spondylitis are well known. The authors discuss the pathophysiological mechanisms, the diagnostic difficulties of such lesions in patients referred for chronic spinal pain, and the choice of treatment. CONCLUSION: Surgical treatment was considered necessary in view of the mechanical solicitations of the mobile segment. A double approach, both anterior and posterior, gave good results and is advocated by the authors.
PURPOSE OF THE STUDY: The authors describe the surgical treatment of three cases of vertebral pseudarthrosis in two patients suffering from rheumatoid spondylitis for an average of 20 years. MATERIAL: Two pseudarthrosis involved the thoracic level (T9-T10 and T10-T11), after an insignificant trauma. In the other case, the lesion was a secondary localization (L5-S1) arising spontaneously two years after the treatment of a T10-T11 lesion. Initial conservative treatment was unsuccessful in all three cases. Anterior surgery was performed in all three cases. In two out of the three, posterior surgery was associated with the anterior approach. RESULTS: After surgery, the three lesions healed. DISCUSSION: Extensive discovertebral lesions during the course of rheumatoid spondylitis are well known. The authors discuss the pathophysiological mechanisms, the diagnostic difficulties of such lesions in patients referred for chronic spinal pain, and the choice of treatment. CONCLUSION: Surgical treatment was considered necessary in view of the mechanical solicitations of the mobile segment. A double approach, both anterior and posterior, gave good results and is advocated by the authors.