Arthritis and the Spine

Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that affects the spine. Pain and stiffness occur from the neck to the lower back. The spine is very rigid.  Bones in the spine can fuse together further reducing spinal flexibility.  Pain also occurs in the ligaments and tendons because of the unusual posture and inflammation resulting from lack of movement.  Sometimes this disease can begin rarely in men in their teens and twenties. Fever, fatigue, and poor appetite often herald this disease. Eye inflammation can occur and the cardiopulmonary system may be affected. There is a genetic link with individuals who have a gene called HLA-B27.  

Diagnosis and Treatment

Diagnosis can be made with a thorough clinical examination, lab tests that look for inflammation and genetic markers, as well as x-ray evaluation. CT scans of bony areas and ultrasound to investigate the joints can be performed to evaluate the extent of the joint damage and rigidity.

Treatment includes chemotherapy medications such as methotrexate, non-steroidal anti-inflammatory agents, and a new class of medications called Biologics. Anti-depressants are often used to treat pain. Sometimes a surgical approach is needed to artificially replace joints or release pressure on spinal roots.

Degenerative Disc Disease

Between your spinal bones, soft, spongy discs absorb pressure and reduce the shock of movement. These discs in the back can break down, extruding a jelly-like material, or can bulge between the spinal bones and entrap spinal nerves as well as cause irritation. As you age, your spinal canal can narrow and put additional physical pressure on these pads. Tears or cracks in the disc can cause pain, discomfort, and disability. Smoking, obesity and a lifetime of heavy, repetitive motion all contribute to disc deterioration.

Diagnosis and Treatment

Clinical examination, bony imaging, and electromyelograms to evaluate spinal nerve function are all used to evaluate the extent of spinal damage and disc damage. Sometimes special spinal imaging is used to further evaluate the spinal canal and its size.  

Physical therapy can be used to straighten and strengthen the spine, decrease rigidity, and improve function. All underlying and contributing conditions must be adequately treated to achieve the greatest degree of success. Exercise, diet, and treatments to improve balance, agility, and body strength are essential. Medications such as non-steroidal  anti-inflammatory pills can be prescribed. Surgical evaluation may be necessary if a bony fracture or significant nerve pressure is diagnosed on spinal imaging studies.