CLINICAL SYNDROMES OF THE “INNOCENT” FORRESTIER’S DISEASE

Abstract

Introduction: Described by Jacques Forrestier at the beginning of the 20th century, the disease was named ankylosing hyperostosis of the spine1. Since that time various other names have been accorded to it, the most comprehensive being dish: diffuse, idiopathic, skeletal, hyperostosis2. The disease is often misdiagnosed by radiologists, unrecognised by surgeons and considered a silent condition. To diffuse this myth of ‘innocence ‘ I am presenting syndromes collected from over 80 patients, during some 20 years.

Methods: the clinical syndromes were recorded, with emphasis on general health and family history. The physical examination recorded the rigidity of spinal movements and neurological changes. All patients were exposed to plain films and CT scan of the spine, to barium meal and /or laryngoscopy.

Results: Only clinical assessment and radiological illustrations were the aim of this review: Cervical syndromes: – painful ankylosis; stenosis with myelopathy (3);

• -Tracheal compression with laryngeal nerve palsy;

• -Esophageal compression with endoscopic implications. (4).

Dorsal syndromes: painful ankylosis, spinal stenosis & myelopathy (5,6,);

Lumbar syndromes: painful hyperlordotic ankylosis, spinal stenosis (7);

Sacroiliac fusion (8); calcifications of iliosacral and iliolumbar ligaments.

Extra spinal calcifications: peri articular at elbow, hips and in operative scars: Achilles’ repair; Post-laparatomy abdominal wall ossification (9).

Particular features: early onset (age 40); incidence in families with two brothers and another with three brothers.

Discussion: Presentation of multilevel spinal syndromes and extra-spinal symptomatic calcification/ossification is intended to dispel the “innocence” of this disease. Except the ankylosis, often asymptomatic, the approximate symptomatic disease was found to be of 10%.