• Littrell TA
• Johnson J

• Case Reports
• Hyperostosis, Diffuse Idiopathic Skeletal / diagnosis
• Male
• Middle Aged
• Open Access Document
• Spondylitis, Ankylosing / diagnostic imaging

Background: Diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis are conditions characterized by ossification of ligament and tendon attachments to bone, mainly impacting the axial skeleton, causing symptoms of spinal stiffness and pain. Sacroiliac joint disease is a prevalent feature of ankylosing spondylitis and has long been used as an exclusion criterion for diffuse idiopathic skeletal hyperostosis.

Case Presentation: A 54-year-old White male with a 16-year history of diagnosed but untreated ankylosing spondylitis sought care at a chiropractic clinic for chronic neck pain and spinal stiffness. Physical examination yielded findings of reduced spinal motion, hypokyphosis, and hypolordosis. Thoracic and lumbosacral radiographs revealed findings of partial sacroiliac joint ankylosis, syndesmophytes, squared vertebrae, and ossified posterior spinal ligaments. The Cervical radiographs demonstrated thick bulky ossification of the cervical anterior longitudinal ligament with minimal disc degeneration.

Results: The patient’s prior diagnosis of ankylosing spondylitis was confirmed, along with a new diagnosis of concurrent cervical diffuse idiopathic skeletal hyperostosis. Treatment with spinal manipulation or with adjunctive therapies was deferred, pending rheumatology consultation.

Conclusion: Spinal stiffness, pain, and postural changes are common clinical features of both ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis. Distinction between the two diseases is aided by evaluation of the radiographic findings. The radiographic evidence of sacroiliitis has historically excluded the diagnosis of diffuse idiopathic skeletal hyperostosis. This case report describes concurrent diagnoses of ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis that have thus far been rarely reported in scientific literature and reviews the clinical features, radiographic findings, and complications of each disease. 

Author keywords: Ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, HLA-B27, syndesmophytes, spondyloarthropathy

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