Definition:
Ankylosing Spondylitis is a chronic
inflammatory condition of the spine and sacro-iliac joints characterised by
osseous proliferation and the development of a progressive kyphotic spinal
deformity in the most severe classical cases.
Incidence:
The disease affects approximately 1 per
every 1,000 people with a lower incidence in black Americans.
Classic Ankylosing Spondylitis
affects males more commonly than females, but the overall incidence is similar
and symptoms usually develop between 15 - 25 years of age.
Clinical Features:
The onset is usually insidious
with the development of back-ache and stiffness.
In women the diagnosis may be
delayed but progressive disease is less common and there is usually more
peripheral joint, and less spinal involvement.
In the classical form there is
loss of spinal mobility (extension first) with flattening of lumbar lordosis.
Ocular inflammation occurs in
about 1/3 of patients (uveitis in about 20% and conjunctivitis in 25%).
Active inflammatory disease may
be associated with weight loss, fatigue and a low grade fever.
Treatment:
Anti-inflammatory medication,
analgesics and physiotherapy help to relieve symptoms and maintain movement.
Rest and immobilisation is
contraindicated as this tends to increased
osteoporosis, deformity and the restriction of joint and spinal movement.
Where spinal deformity is
severe, restricting function and mobility, a spinal osteotomy (lumbar or
cervical) may become indicated to improve the patients "outlook on
life".
The images above display the pre-operative radiograph
and clinical photograph of a patient with Ankylosing Spondylitis. The
post-operative x-ray and clinical photograph is also shown for comparison.
A spinal osteotomy is however a major operation with
associated significant risks, and is only indicated when deformity is severe
and associated with significant disability.
Prognosis:
The age of the individual at the
onset of symptoms is the most important factor in determining the prognosis
and outcome.
