Ankylosing spondylitis (Bechterew's disease)
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Ankylosing spondylitis is a chronic progressive inflammation of the joints of and adjacent to the spine. It eventually leads to fusion of the joints and is associated with weakening of the bones. Some patients have genetic predisposition to develop the disease. Not all patients with a genetic predisposition develop the disease.
At the later stages of the disease spine deformities may occur. Aside from spinal symptoms, patients suffer from inflammation in the eyes (in 25-30% of patients), heart and blood vessels, lung, kidney, etc.
CAUSE OF SYMPTOMS
Gradually progressing inflammation and degeneration in the intervertebral joints
Gradually progressing inflammation and degeneration in the sacroiliac joints
SYMPTOMS AND SIGNS
Fatigue, weight loss, loss of appetite, leg weakness, fever, shortness of breath
Pain and stiffness along the spine
THE DIAGNOSIS IS BASED ON Medical history Clinical exam Magnetic resonance imaging (MRI)
Blood tests Computer tomography
additionally you may have to do: Bone scan
A computer tomography image of the lumbar spine of a patient with Bechterew's disease
Treatment is usually non-surgical.
Non-surgical treatment may include Corticosteroids Nonsteroidal anti-inflammatory drugs Sulfasalazine Methotrexate
Internaarticular corticosteroid injections Physiotherapy Rehabilitation
Immobilization with brace Bisphosphonate therapy
WHEN SHOULD AN OPERATION BE PERFORMED?
Due to the multilevel bony fusion (long lever arms) and weak bone substance (osteoporosis) operations of the spine in Ankylosing spondylitis (Bechterew's disease) are very complex and involve many risks. Therefore, surgical corrections are rarely indicated.
WHAT IS THE GOAL OF SURGERY?
To release the compressed nerve roots and/or spinal cord
To restore the protective function of the spine
HOW IS SURGERY PERFORMED?
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Diffuse idiopathic skeletal hyperostosis Reiter's syndrome Arthritis Sacroiliac joint pain
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