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A 26-year-old wheelchair-bound man was brought to our institute with progressive painful deformity of both lower limbs involving bilateral hip and knee for the past 5 years. The patient was wheelchair-bound for the past 18 months. He was only able to crawl to meet his locomotor demands. On examination, the patient was in a crouched posture with mild kyphosis at the thoracolumbar region and ankylosis of bilateral hip and knee in an unfavourable position. Radiological and serological evaluation diagnosed him to be a case of neglected ankylosing spondylosis. We planned for arthroplasty of the bilateral hip and knee for correcting his posture and to regain his locomotor ability. The severity of the deformity mandated extensive releases and the handling of neurovascular structures. Hence, a holistic treatment plan with various surgical strategies was devised to manage his deformities. The patient made a good recovery and regained his locomotor ability without any major complications at a 2-year follow-up.

Background Vertebral fractures are the hallmark of bone fragility and are frequently present in patients with ankylosing spondylitis (AS). For treating rheumatologists, it is important to know which patients already have vertebral fractures and which patients are at risk to develop new fractures. Limited longitudinal data are available concerning the development of new vertebral fractures in AS. Objectives To investigate the prevalence and incidence of radiographic vertebral fractures and the association with patient characteristics, clinical assessments, and medication use in a large prospective cohort of patients with ankylosing spondylitis (AS) in daily clinical practice. Methods Consecutive AS patients from the Groningen Leeuwarden AS (GLAS) cohort with baseline and 2-year lateral radiographs of the thoracic and lumbar spine were included. Radiographs were scored for vertebral fractures by two readers according to the method of Genant et al . Vertebral fractures were defined as ≥20% reduction in vertebral height. Severity of fractures were divided into mild (20–25% reduction), moderate (25–40% reduction), and severe (>40% reduction) fractures. Differences in baseline characteristics were explored between patients with and without radiographic vertebral fractures. Results Of 292 included AS patients, 70% were male, 82% HLA-B27+, mean age was 43±13 years, median symptom duration 16 (IQR: 8–25) years, and mean BASDAI 5.3±2.2. Radiographic vertebral fractures were present in 59 (20%) patients at baseline. During 2 years of follow-up, 15 (6%) patients developed new vertebral fractures and 7 (2%) showed an increase in severity of existing fractures. Most fractures were mild and located in the mid-thoracic and thoracolumbar region of the spine. The presence of vertebral fractures was significantly associated with older age, higher BMI, longer smoking duration, larger occiput-to-wall distance, more spinal radiographic damage, and lower hip BMD. Occiput-to-wall distance was identified as an independent risk factor for prevalent vertebral fractures; 44% of the patients with hyperkyphosis (occiput-to-wall distance ≥10 cm) had vertebral fractures. The development of new or progressive vertebral fractures was also associated with older age and low BMD. Patients using NSAIDs at baseline showed less prevalent (18% vs. 31%) and incident (5% vs. 17%) vertebral fractures than patients without NSAIDs. Conclusions In this large AS cohort in daily clinical practice, radiographic vertebral fractures were frequently present, especially in older patients with more advanced disease, low hip BMD, and a less healthy lifestyle. Interestingly, NSAID use was associated with a reduced vertebral fracture risk. Acknowledgement The GLAS cohort was supported by an unrestricted grant from Pfizer. Pfizer had no role in the design, conduct, interpretation, or publication of this study. Disclosure of Interest F. Maas: None declared, A. Spoorenberg Grant/research support from: Abbvie, Pfizer, UCB, Consultant for: Abbvie, Pfizer, MSD, UCB, Novartis, B. van der Slik: None declared, E. van der Veer: None declared, E. Brouwer Grant/research support from: Pfizer, H. Bootsma: None declared, R. Bos Grant/research support from: Pfizer, F. Wink Consultant for: Abbvie, S. Arends Grant/research support from: Pfizer

Migration of neurogenic spinal tumours is uncommon. However, such possible mobility should be kept in mind during surgery for neurogenic tumours whenever the lesion is not found at the anticipated level. Conventional static imaging techniques, such as myelography and MRI, have not documented dynamic motion of tumours. A 12-year-old boy was diagnosed with a neurogenic spinal tumour in the thoracolumbar region. To assess the migratory tendency of the tumour, cine MRI was performed to acquire dynamic images under postural change. Cine MRI showed that the tumour migrated up to the lower part of the T12 vertebra from the upper part of the L1 vertebra during a change in spinal posture from cervical flexion to extension. The tumour was completely removed and histological examination revealed the tumour to be an ependymoma. Cine MRI is useful for dynamically and non-invasively assessing the migratory tendency of spinal tumours.

Four sibs of non-consanguineous parents who had myotonia from late infancy are described. Mild to moderate mental retardation, severe bone abnormalities of the vertebral column (mainly in the thoracolumbar region), and short stature were also observed. Autosomal recessive inheritance is demonstrated. These cases are compared with reported cases of the Schwartz-Jampel syndrome.

Between 1954 and 1984, 38 patients were seen as a result of gymnastic activities. Thirty three were men, five were women, and their ages ranged from 12 to 54, the mean age being 20. Thirty one had spinal injuries (28 in the cervical region, three in the thoracolumbar region), two no definite injury, and for five the information was incomplete. The accidents occurred largely because gymnasts landed on their heads, the force being transmitted to the cervical spine. Most took place in gymnasiums and were caused by a failure of supervision.