It won’t be wrong if we say that spinal issues have become very common these days. Work from home, poor posture, less sleep and irregular physical activeness have taken a toll on our overall health and spine is too affected by it. Spondylitis is a condition that makes causes inflammation and pain in your spinal bones. If you look at numbers, over a million cases of spondylitis are identified every year and this has only increased in the past year. However, most people remain uninformed of this disease and dismiss it to be normal back pain. Only after pain and swelling increase, they get it assessed and find out about Spondylitis. In this article, we will talk about different types of Spondylitis as explained to us by Dr. Vamsi Krishna Varma Penumatsa, Sr. Consultant Spine Surgeon at Yashoda Hospital, Hyderabad.
Types of Spondylitis in Spine
The three types of Spondylitis in spinal bones are:
- 1) Ankylosing Spondylitis
- 2) Rheumatoid Arthritis
- 3) Diffuse idiopathic skeletal hyperostosis
Let us explain them one by one.
This type is more common in people aged above 45, however, anyone can get this. In this condition, inflammatory back pain is caused due to inflammation in the pelvis or spine. You are highly likely to experience stiffness after waking up and this can get better with gradual physical activity. If left untreated, a new bone may form in the spine in an immobile position and the pain can extend to shoulders, hips, joints and ribs.
- Systemic seronegative inflammatory disorder associated with sacroiliitis and inflammatory alteration at the axial skeleton.
- 90% of cases associated with HLA b27
- The male female ratio is 2-7:1
- Onset is usually between 15 – 35 years of age
- Imaging modalities are radiographs and MRI
- CT is useful for diagnosing occult fractures.
- Treated non-operatively by analgesics, anti-inflammatory drugs, physiotherapy and rehabilitation
- Unstable spinal fractures, kyphosis related progressive myelopathy, sagittal imbalance are indications for surgery
Almost all of us know about this but as arthritis and not spondylitis. This is actually a type of spondylitis. Here are some pointers for better understanding.
- Approximately 40 % of patients with rheumatoid arthritis show pathology in the cervical spine especially atlanto axial segment
- Tissue destruction causes instability of the atlanto axial segment
- Compressive myelopathy is the consequence of instability and repetitive trauma
- Cardinal symptoms are sub occipital pain, pain exacerbation on head rotation
- Standard radiograph and MRI are the imaging modalities of choice
- Conservatively managed with analgesics and DMARDS with regular follow up
- Early surgery prevents extensive and risky interventions
Neck pain is the most common indication for surgery, but neurological symptoms with myelopathy might be the primary cause of surgery. Every patient of rheumatoid arthritis should have a lateral flexion radiograph of the cervical spine performed at least 3-5 years.
Diffuse Idiopathic Skeletal Hyperostosis
This is characterized by enthesopathy of the spine and extremities, which usually presents with back pain and spinal stiffness.
- Uncommon before 50 years
- Most common in thoracic>cervical>lumbar
- Flowing ossification along the anterolateral aspect of at least 4 contiguous vertebrae
- Preservation of disk height in the involved vertebral segment
- Absence of facet-joint ankylosis; absence of SI joint erosion, sclerosis or intra articular osseous fusion
- Often asymptomatic, discovered incidentally
- Mild back pain, morning stiffness are the symptoms
- Non operative treatment includes activity modification, physiotherapy and analgesics
- Operative management reserved for deformity and occult fractures
Spondylitis is a common issue that majorly occurs in spinal bones but is not restricted to it. It can travel to other parts of the body making it difficult to treat it. Thus, identify the symptoms and resolve them with the help of a medical expert.
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