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Lumbar Ankylosing Spondylitis

What does the word “Ankylosing Spondylitis” mean?

The word “Ankylosing Spondlitis”(AS) comes from two Greek words, “ankylos”, meaning “stiff” and ”spondylos”, meaning “vertebrae”. So, it means “stiff vertebrae”.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a condition of the spine where spinal joints become inflamed, similar to Rheumatoid Arthritis. In both cases, the body sees these joints as foreign material and tells the immune system to attack it (autoimmune disease). In AS, all the spine joints including the sacroiliac joints can be affected. After long periods of severe inflammation of these joints, they eventually fuse (mend together) on their own, resulting in “stiff vertebrae”.

Are other organs also affected by Ankylosing Spondylitis?

Other organs such as the eyes, heart and kidneys can also be affected by this disease.

Who gets Ankylosing Spondylitis?

AS is a disease most commonly seen in males between 20-40 years of age, and is passed on through families (genetic link). 90% of patients with AS, have a specific gene (HLA-B27), which can be inherited.

What kind of symptoms do patients with Ankylosing Spondylitis get?

The initial symptoms of AS can be vague. This can make it difficult to diagnose the disease in its early stages.

On average, the first symptoms are present by the age of 23.

In more advanced stages, the following symptoms may be present:

  1. Stiffness in the back and other joints
  2. Pain in the spine, most often mid-back (thoracic spine)
  3. Pain in the buttock and thigh area (from sacroiliac joint pain)
  4. Loss of mobility of the spine

How do Spine Specialists diagnose Ankylosing Spondylitis?

Spine specialists use the information from the patient history, physical examination and specific tests to make this diagnosis:

  1. History

A history of slowly worsening stiffness and pain in the middle of the spine or over the hip bones may tip a doctor off to the diagnosis.

A family history of AS can be very suggestive when a patient has symptoms.

      2. Physical Examination

AS can be difficult to diagnose with a physical examination. Here are some examination techniques a doctor may use:

  • Looking at the spine (inspection)
  • Touch and pressure of the spine (palpation)
  • Mobility testing (Range of Motion)
  • Strength testing (motor exam) of the legs
  • Sensation testing (sensory exam) of the legs
  • Reflex testing of the legs
  • Sacroiliac joint testing:
    • Pelvic Rock test
    • Gaenslen’s test
    • FABERE’s test
    • Patrick’s test


      3. Tests

  1. Imaging

 a. X-Rays                                          

X-Rays of the spine can show signs of AS when the disease has progressed to involve the discs and joints of the spine. The discs can be seen getting thinner and eventually virtually disappear. However, it can take up to 10 years before X-Rays can show the diagnosis of AS.

X-Rays of the Sacroiliac joints can show joint degeneration and loss of joint space.

b. CT Scans

CT scans can show the bone anatomy of the spine and sacroiliac joints in detail. The loss of joint space from AS can be clearly seen in advanced cases.

c. MRI Scans

MRI scans can show degeneration and inflammation of the discs and joints of the spine. Specific bone details are better seen on a CT scan.

d. Blood tests

  • HLA-B27, the genetic marker for AS can be found on a blood test
  • Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP)

Elevated levels of inflammatory markers in the blood can point towards an inflammatory spine conditions such as AS.

How is Ankylosing Spondylitis treated?

There is no cure for AS, but here are some treatments which can help with the symptoms.

  1. Non-Surgical Care

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage therapy techniques can help with the muscle components of AS.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms.

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition. Chiropractic care such as spine manipulation is usually reserved for earlier states of the disease. In the later stages spine manipulation could possibly fracture a vertebra.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. Specific exercises to improve the spine’s mobility can lessen the symptoms. Aquatic therapy can be very beneficial.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  1. There are a number of medications available which depress the immune system. Since the immune system is attacking the joints in AS, depressing it can slow the disease or possibly put it in remission. These are called “Disease-Modifying Antirheumatic Druges (DMARDS) and include Cyclosporin, Sulfasalazine and Methotrexate amongst others.
  2. Another category of medications are called Tumor necrosis factor-alpha (TNFα) blockers.
  3. Non-steroidal Anti-inflammatory Drugs (NSAIDS)
  4. Steroids
  5. Muscle Relaxants
  6. Pain Killers


H. Injections

Injections can offer some help for AS patients, especially in the early stages of the disease. Here are some injections with may help:

  • Trigger Point Injections
  • Lumbar Interlaminar Epidural Steroid Injections
  • Lumbar Facet Joint Injections
  • Lumbar Facet Joint Radiofrequency Rhizotomy


      2. Surgical Care

Surgery of the spine is usually not required, unless a spine fracture occurs. These fractures tend to heal poorly and may have to be treated with surgery. Here is a surgical option:Lumbar Fusion