Ankylosing Spondylitis & Spinal Deformities
What Is Ankylosing Spondylitis (AS)?
(AS) is an inflammatory disease that can cause some of the vertebrae to fuse over time. Naturally, this can lead to the spine becoming less flexible, which results in a hunched-over posture. Kyphosis is the term used to describe this condition. It is also possible for the spine to fuse together like a rigid stick of bamboo. This irreversible deformity is aptly called bamboo spine due to the way in which the backbones fuse together. Spinal rigidity such as this can lead to nerve compression and cause numbness in other parts of the body. Breathing problems may also be present in certain cases, affecting the ribs.
(AS) is more likely to affect men than women, with signs of (AS) developing in early adulthood. Additionally, people with (AS) have a chance of passing the condition on to their children. On top of that, gene HLA-B27 is commonly found in people with (AS). Most commonly, the eyes become inflamed. However, inflammation can also occur in other parts of the body as well, such as the spine.
Presently, there is no cure for (AS). That being said, there are steps that one can take to lessen the symptoms of the condition. In some cases, treatment can slow the progression of the disease.
How Do I Know if I Have The Symptoms of Ankylosing Spondylitis (AS)?
Typically speaking, (AS) affects the joints of the spine. The early stages of (AS) usually involve low back pain and stiffness. These symptoms will often occur before doctors can visibly see them on an x-ray. In many cases, it can take up to 5 years for detection on an x-ray to occur. Symptoms may include:
- Bone Fusion: This is an overgrowth of bones at the joints. This can make carrying out day-to-day tasks very difficult. It can sometimes lead to restricted movement in the chest and cause breathing problems.
- Fatigue: People with (AS) often feel tired or lack energy in general
- Pain & Stiffness: This is the main symptom. This can occur in many different places. Commonly cited places include the back and hips (especially after sleeping). Neck fatigue and pain is also common. It can also include other joints, tendons, and ligaments, such as behind and under the heel of the foot.
- Sacroiliitis: Usually the first sign of (AS), this affects the sacroiliac joints in the lower back. These joints are located where the tailbone meets the bones connected to both sides of the buttocks. When the sacroiliac joints become inflamed, it causes pain in the low back and buttock areas.
- Iritis: This occurs when the iris of the eye becomes inflamed. Iritis causes pain and redness in the eye. But usually, it does not affect vision. This is found in 25% of patients who are affected by (AS)
- Limited Mobility: (AS) causes bones in the vertebrae to fuse, which leads to conditions such as bamboo spine and kyphosis. When this happens, the spine becomes a lot less flexible, in turn limiting mobility.
If you think you have (AS), then contact Dr. Jason E. Lowenstein today. He is a leading expert in the field of spinal deformity care.
Diagnosis of Ankylosing Spondylitis (AS)
There are several steps that a doctor can take to make an (AS) diagnosis. Generally, this includes x-rays, laboratory tests, and a history/physical examination.
There are certain signs in a patient’s history that can make an (AS) diagnosis plausible, such as:
- A family history of (AS)
- Onset of back pain before age 35-40
- Gradual onset of pain (not from trauma)
- Spinal stiffness after long periods of inactivity (such as sleep)
- Pain that has lasted longer than three to six months
- Improvement with motion and exercise
A doctor may use x-ray imaging to look for signs in the spine and pelvis. Vertebral body deformation is a common sign in x-rays. Usually, these deformed bodies take on an abnormal square shape. Bamboo spine is the term used to describe this condition. In a bamboo spine, the appearance is very symmetrical and unsegmented when revealed with x-ray imaging.
Early x-ray findings will be seen around the sacroiliac joint (SJ). Usually, these findings will appear on both sides. These signs include:
- Poorly defined joint margins
- Patchy osteoporosis (loss of bone mass)
- Erosions of the joint
- Widening of the (SJ) space
In more advanced cases of (AS), x-rays may show even more changes. In such cases, old spinal compression fractures, calcium deposits in discs and ligaments, and complete spinal fusion may appear.
Unfortunately, there is no blood test that can determine whether or not a patient has (AS). That being said, the presence of genetic marker HLA-B27 in the blood shows up very often in people with (AS). In fact, 80-95% of patients with (AS) have this gene.
Aside from the presence of the mentioned gene, blood tests can show evidence of increased inflammation in the body. Erythrocyte Sedimentation Rate (ESR) is what determines this increase. This test will show any inflammation in the blood from any cause. However, with that in mind, a common cold will increase results significantly.
In some cases, kidney abnormalities can cause similar symptoms to (AS). The test for kidneys is a urinalysis This test is done to rule one of these two options out.
How Dr. Lowenstein Can Help
While there is no cure for (AS), there are effective treatment options that can improve the condition and relieve pain. Before surgery is considered, more conservative treatment plans are normally tried first. This, however, depends on the severity of the condition and the expert opinion of the doctor.
NSAIDs are commonly given to patients experiencing (AS). The most common prescription for (AS) is usually indomethacin. Only take medicines advised or prescribed by your doctor. In some cases, it may be best to take the medications with food to ward off possible side effects. Side effects may include abdominal pain, diarrhea, and nausea. Overall, NSAIDs are the preferred treatment choice for patients with (AS).
In the event that the NSAIDs do not provide ample relief, sulfasalazine may be suggested. Corticosteroids may also prove effective at reducing inflammation. That being said, they can have serious side effects if they are taken on a long-term basis.
If all else fails, a doctor may recommend TNF blockers to patients with (AS). These inhibitors are made from the antibodies of animal or human tissue. Once put into the blood, they cause a reaction in the immune system and can block inflammation as a result. These are not given out often, as they have many side effects and need to be monitored closely. However, some patients find that they are very effective in treating their inflammation.
Physical therapy is considered to be one of the most important treatments for (AS). Movement done during this treatment will help the spine regain its mobility as well as improve its posture.
On top of that, a well put-together exercise program can provide relief in many patients with (AS). To develop an appropriate exercise routine for your case, consult your physical therapist and stick with his/her plan. A physical therapist may also advise you to:
- Not use a pillow while sleeping (this prevents kyphosis)
- Maintain high activity levels
- Avoid prolonged bed rest and sitting
- Do daily deep breathing and stretching exercises
- Perform non-jarring exercises regularly (like swimming)
- Learn proper body mechanics (such as how to maintain an erect posture to fight kyphosis)
Most of the time, surgery is not performed on patients with (AS). That being said, it may be deemed necessary by your doctor if the disease has led to a severe deformity. An example of this would be extreme kyphosis that prevents the patient from looking forward and standing. In such a case, a posterior column or pedicle subtraction osteotomy may be performed. In this operation, the spinal bones are cut and realigned into a position that allows the patient to have better posture. Of course, the spinal vertebrae is only cut and not the spinal cord.
In other cases, surgery may be recommended if the arthritis associated with (AS) has affected the hip bones. An artificial hip replacement may be required in cases where the hips are severely damaged by arthritis. As far as surgical treatments go for (AS), this is the most common procedure.
If you believe you have (AS), please contact Dr. Jason Lowenstein and his team of (AS) experts. Dr. Lowenstein is a founding member of the Advanced Spine Center and its medical director of spinal deformity. He specializes in treating spinal deformities such as pediatric and adult scoliosis, spondylolisthesis, and kyphosis. In addition, he is an expert in minimally invasive spinal procedures, like ankylosing spondylitis surgery.