This is a X-ray showing the part of the vertebral column and the pelvis of a 32 years old man who came to the hospital complaining of insidious onset of lower back pain  for more than 2 months period.He complained that back pain persisted, even at rest.And The back pain is associated with spinal stiffness in the morning.
What is the Diagnosis?
What are important Xray signs that can be elicited in Xray spine?



ANSWER - Ankylosing Spondylitis(Bamboo Spine and Bilateral Sacroileitis)



Ankylosing spondylitis is a chronic, inflammatory arthritis and autoimmune disease.It primarily affects the cartilaginous joints of the spine and the sacro-ilium of the pelvis.Male  are affected more severely and more often  than females. The mean age of onset is between 26 years of age.Its associated with HLA-B27  and other seronegative spondarthritides such as Reiter's disease, psoriatic arthritis or enteropathic arthritis.

CLINICAL FEATURES
Articular manifestations of ankylosing spondylitis include:
  •     Backache and stiffness usually worse after inactivity or on waking in the morning 
  •     10% of cases have swollen and tender peripheral joints
  •     All movements of the spine are reduced, especially extension, resulting in
           failure to obliterate lumbar lordosis on forward   flexion
           reduced chest expansion
           complete rigidity due to ankylosis
  •      Pain over the iliac crest
  •      Atlanto-axial subluxation
  •      Osteoporosis

The extra-skeletal manifestations of ankylosing spondylitis are:

  •      Cardiac complications:
           Aortic regurgitation
           Conduction defects
           Carditis

  •      Pulmonary fibrosis
  •      Ocular involvement:anterior uveitis(redness, eye pain, vision loss, floaters and photophobia)
  •      Amyloidosis
  •      Neurological complications
           spinal fractures
           cauda equina syndrome

INVESTIGATIONS
     Radiological Imaging
Erosion, sclerosis and ankylosis of the sacroiliac joints
'Bamboo spine' appearance - bony bridges between neighbouring vertebrae 

    FBC - leucocytosis
    ESR - elevated
    CRP - raised
    Hypergammaglobulinaemia
    Negative rheumatoid factor

TREATMENT
Physiotherapy and physical exercises along with medications


Pharmacological
NSAID's and analgesics
DMARDs such as ciclosporin, methotrexate, sulfasalazine
TNF╬▒ blockers
 

Physiotherapy and physical exercises
Swimming, one of the preferred exercises
Slow movement muscle extending exercises like stretching, yoga, climbing,ect
 

Surgical Interventions
Vertebral osteotomy to treat severe flexion deformity
total hip replacement to treat affected hip joints


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4 comments

  1. Anonymous Says:
  2. bamboo spine....ankylosing spondylitis

     
  3. Anonymous Says:
  4. B/L SI jts obliterated.
    Ank spondylitis

     
  5. Anonymous Says:
  6. bilateral sacroileitis and bamboo spine sero negative spondilartropathy probably anklosing spondylitis

     
  7. Anonymous Says:
  8. ankylosing spond

     

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