Multiple vertebral involvement of rheumatoid arthritis in thoracolumbar spine: a case report

Abstract

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.

Keywords: Arthritis, Rheumatoid; Fractures, Bone; Thoracolumbar; Vertebroplasty.

Fig. 1

A plain radiographic examination of the patient's thoracolumbar spine upon admission (A) shows multiple thoracolumbar fractures on T11, L2, and 3, and sclerosis of the vertebral end-plate without evidence of osteophyte formation. An immediate magnetic resonance imaging (MRI) scan (B, C) shows vertebral involvement on T11, L2, L3, and L5 that appeared hyperintense on the gadolinium enhanced images.

Fig. 2

A plain radiograph after 1 month (A) shows a new pathologic fracture in T12 as well as erosion of the L3-4 disc space with surrounding sclerosis and adjacent discs exhibited ballooning. The sagittal T1-weighted MRI (B) shows a marked collapse of T12 with retropulsion of the bony fragments, which is evidence of an acute fracture. The collapsed T12 and other lumbar lesions after gadolinium contrast enhancement (C).

Fig. 3

A plain radiography 6 months after vertebroplasty. The alignment of the spine and the height of the T12 vertebral body were maintained.

Fig. 4

Histology of the fractured T12 vertebra (H&E A×100, B×400). (A) The marrow spaces are filled with acute and chronic inflammatory cells (arrows) together with fibrosis (arrow heads). (B) Higher magnification of the area shows neutrophils, plasma cells and lymphocyte infiltration.