ABSTRACT
The skeleton of a Thai male teacher who died aged 75 was studied. The skeleton showed severe spinal fusion and deformities. We studied the pathological features and hypothesized a diagnosis through a retrospective study of the case history. Pathological findings showed severe spinal ankylosis due to continuous fusion of the vertebral bodies from T2 to L3 and L4 to L5, the apophyseal joints from T2 to L1, the sacrococcygeal and atlantooccipital joints, and ankylosis of the bilateral sacroiliac joints. Ossification of the anterior longitudinal ligaments from T2 to L3 and the supraspinous ligament from T6 to T12 and L4 to L5 were observed. Kyphosis and costovertebral ankylosis which obliterated the intervertebral foramina were found at T7, T8 and T9. Synostosis of C2 to C3 and ossification of the right sacrotuberous ligament were observed. Enthesopathy was seen in the sternocostal radiate ligaments and also the lower limb ligaments and tendons. These features are characteristic of severe progressive ankylosing spondylitis. The case history recorded no report of clinical manifestations of spinal problems. The patient was healthy until the last 2 to 3 years of his life, when he exhibited difficulty leaning sideways, breathing, and had chest pain. He was diagnosed and treated for ischemic heart disease but suffered from breathing difficulties until he died. He was never diagnosed with ankylosing spondylitis.