Ankylosing Spondylitis

Ankylosing spondylitis (and other seronegativespondyloarthropathies) is a disease characterized by inflammation of the joints between spinal bones (sacroiliac joints, facet joints and discs). It may be associated with inflammation in other joints like hips and knees. Due to the inflammation, patients may complain of pain; morning stiffness; decreased motion in the neck and back; and a progressive tendency of the back to develop a hump (hindi – kubb). Ankylosing spondylitis frequently affects men between 20-40 years and is fairly common in India. Ankylosing spondylitis has a genetic predisposition and can run in families.

These patients often present first to a Spine Surgeon with back and neck pain, who will make a diagnosis of Ankylosing Spondylitis on the basis of the clinical picture and X-rays of the spine and pelvis. Some basic blood tests like ESR, CRP and HLA-B27 will also help in the diagnosis and prognostication.

The mainstay of treatment of Ankylosing Spondylitis is anti-inflammatory medicines. These are best initiated and monitored by a Rheumatologist (Superspecialist in management of Arthritis). Yoga, spinal exercises, chest exercises and postural training also benefit patients with ankylosing spondylitis. Yoga asanas like the Bhujangasana are very helpful to these patients.

Patients with Ankylosing Spondylitis are prone to fracturing their neck and back even with trivial trauma like a fall at home or a slip in the bathroom.They may also develop pseudoarthrosis (Anderson’s lesion) in the spine even without any obvious trauma. Therefore, any increase in neck or back pain (especially after a fall or slip) or a change in the alignment of the spine should never be neglected in a patient with ankylosing spondylitis.

All such patients should receive Xrays and CT of that part to rule out a fracture. Fractures in ankylosing spondylitis always need fixation, as they are always unstable with a tendency for displacement and spinal cord injury. Fixation for these fractures is done using longer constructs than that used in routine fractures.

Patients with ankylosing spondylitis with a severe bend (kyphosis) in the neck and back may seek the opinion of a spine surgeon for correction of their deformity. This is a major operation, but can be done safely by performing an osteotomy (usually Pedicle Subtraction Osteotomy) of the spine under neuromonitoring.