(Frank Paul) Folks, it is rare that I comment on the board, but the topic of spine is an intriguing one.Ankylosing spondylitis ( AS) is a seronegative spondyloarthropathy and a chronic inflammatory disease of the axial skeleton that leads to partial or complete fusion and rigidity of the spine. So, my experience suggests that it is best to spine bamboo rods as Tony suggests. Currently I am working on three bamboo rods and two of them needed spine adjustment while a third rod just seemed to come out without much spine problem.
Patients with AS are at an increased risk of osteoporosis and pathological fractures ( chalk stick fractures). In severe cases, surgery (e.g., arthroplasty) may be considered to improve the patient's quality of life. Pharmacotherapy for AS includes NSAIDs and/or TNF-α inhibitors (e.g., infliximab, adalimumab, etanercept).
2007 66:24.Delayed cervical computed tomography scan showed ossification of the anterior longitudinal ligament, calcification of the intervertebral discs and complete vertebral fusion (so called bamboo spine) with transversal fracture at C5-C6 disc level (so called carrot-stick fracture) causing a luxation of the cervical spine with significant compromise. Clinical relevance of vertebral fractures. 1.McGonagle d, gibbon w, emery p. Management of nonradiographic axial spondyloarthritis is the same as for AS.Bamboo spine deformity.
The Bamboo Spine Rite Mattress Trusted Qualities. Chronic inflammatory arthritis affecting the axial skeletonThe Bamboo Spine Rite mattress is firm enough to provide superb support, and still soft enough to be comfortable. Ankylosing Spondylitis: Too Late for Dad, Not for Girl
Abstract, ancient, antique, background, bamboo, book, brown, cardboard, crumpled. Old mulberry paper texture background with bamboo leaves texture background. Affected individuals are commonly positive for HLA-B27.Close up to Texture of Bamboo spine showing sharp thorn in the wood. Weight Limit 90kg per person.
Up to 30% of affected individuals will progress to AS within 10 years of diagnosis.Epidemiological data refers to the US, unless otherwise specified. The majority of patients have sacroiliitis detectable on MRI. Symptoms of axial spondyloarthritis without features of sacroiliitis or spinal ankylosis on plain radiographs Nonradiographic axial spondyloarthritis ( nr-axSpA) Symptoms of axial spondyloarthritis with inflammatory changes in the sacroiliac joints and spinal ankylosis seen on plain radiographs Ankylosing spondylitis (radiographic axial spondyloarthritis AS)
Tenderness over the sacroiliac joints (SIJ) Pain persists with rest and is also present at night. Age at onset 30 minutes that improves with activity Features of inflammatory back pain ( most common presenting symptom) Clinical features Articular manifestations
Gastrointestinal symptoms : due to associated chronic IBD ( ∼ 5–10% of patients) Secondary to apical pulmonary fibrosis or more widespread interstitial lung disease Due to decreased mobility of the thoracic spine and costovertebral joints Constitutional symptoms such as fatigue , weakness, fever , and weight loss Acute, unilateral anterior uveitis ( most common extraarticular manifestation ∼ 25% of patients)
Apply pressure on the patient's flexed knee. The leg to be tested is placed in a figure-4 position, with the patient's ankle placed on the contralateral knee. Assessed with the patient in the supine position
Lift the upper leg and extend the upper hip with one hand while fixing the pelvis with the other hand. Ask the patient to flex their lower hip and knee to ∼ 90°. Prone position: Lift the leg passively (i.e., extend the hip) with one hand while applying pressure on the ipsilateral SIJ with the other hand. The SIJ can be distracted using the following maneuvers.
X-ray findings equivocal: Obtain CRP (or ESR) and HLA-B27. X-ray findings consistent with AS in a patient with typical features of AS: diagnosis confirmed Initial test in all individuals with suspected AS: x-ray of the sacroiliac joints The patient is asked to touch their toes without bending their knees. With the patient standing, the examiner marks two points on the patient's back: one at L5 and one 10 cm above. Schober testA bedside examination to assess lumbar forward flexion
Further workup for associated conditions may be appropriate depending on extraarticular manifestations.There are several diagnostic criteria for AS (e.g., New York criteria, Rome criteria). Consider imaging of the spine in patients with pain in the cervical, thoracic, or lumbar spine. ≤ 1 classical clinical feature: Consider differential diagnoses of AS. Some (2–3) classical clinical features of AS present: MRI of the sacroiliac joints Only a few classical clinical features of AS: MRI of the sacroiliac joints
Clinical and laboratory findings used in the diagnostic criteria for AS include: A positive HLA-B27 test and ≥ 2 typical clinical or laboratory findings Sacroiliitis confirmed on x-ray or MRI and ≥ 1 typical clinical or laboratory finding Lower back pain for > 3 months in patients < 45 years of age and one of the following:
HLA-B27 : Positive in 90–95% of patients with axial spondyloarthritis Laboratory findings: positive for HLA-B27 ↑ CRP and/or ESR Symptoms relieved within 24–48 hours of full-dose NSAIDs Positive family history for axial spondyloarthritis Extraarticular manifestations: enthesitis (may present with heel pain), uveitis, IBD, psoriasis
Ankylosis : fusion of the articular surfaces Signs of sacroiliitis : erosion and sclerosis (increased radiodensity ) of the sacroiliac joints Characteristic findings (usually symmetrical) Indication: b est initial test to confirm the diagnosis of AS and evaluate disease severity Imaging X-ray Sacroiliac joints (PA view)
A radiodense line running through the center of vertebral bodies on AP view Ankylosis of costosternal and costovertebral joints Loss of lumbar lordosis: abnormal straightening of the spine Suspicion of AS remains after a negative radiograph and MRI of sacroiliac joints
Shiny corners sign: reactive sclerosis of the superior and inferior margins of vertebraeEarly stages of AS may be unidentifiable on x-ray (low sensitivity for early-stage). Syndesmophytes between adjacent vertebral bodies (see “ Syndesmophytes vs. Ossification of outer fibers of the annulus fibrosis resulting in ankylosis (fusion) of intervertebral joints Bamboo spine : seen in later stages and is caused by the following
However, MRI is not routinely required to confirm a diagnosis of AS as specialized MRI techniques and radiology expertise is required to accurately identify AS findings. MRIMRI is the most sensitive method for early detection of inflammatory changes of AS.
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