• Hany El Zahlawy, Yasutsugu Yukawa, Keigo Ito, Hiroaki Nakashima, Masaaki Machino, Yumiko Horie, and Fumihiko Kato.
• Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan. hzahlawy@hotmail.com
• Spine. 2009 Nov 15; 34 (24): E901E905E901-5.

Study DesignCase Report.ObjectiveTo present a case of undifferentiated spondyloarthropathy with sternocostoclavicular arthro-osteitis and osteolyis of cervical body requiring surgical reconstruction of the spine and describing the findings which resembled multiple metastases or infection.Summary Of Background DataSternocostoclavicular arthro-osteitis is not infrequent in Japan. It has been reported in patients with seronegative spondyloarthropathies as psoriatic arthropathy or its variant, palmoplantar pustulosis. Cervical spine involvement in the seronegative spondyloarthropathy is usually in the form of syndesmophytes, subluxations, or facet erosions/ fusions. To the best of our knowledge, this is the first report on severe osteolytic cervical spondylitis associating anterior chest wall disease, to the extent that surgical reconstruction is needed.MethodsA 64 year-old woman presented with neck pain. Cervical spine imaging revealed osteolysis and crumbling of C5 vertebral body. Computed tomography of the thorax showed multiple erosions of the anterior chest wall. Multiple hot spots were detected by bone scan. Biopsies were obtained to exclude neoplasm and infection. Surgical reconstruction via combined anterior-posterior approach was performed to achieve solid spine arthrodesis.ResultsNeoplasm and infection were excluded. Careful reassessment alerted to the diagnosis of undifferentiated spondyloarthropathy. Solid arthrodesis and pain relief could be obtained by surgery together with medical control of the disease.

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