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Ankylosing Spondylitis Related Spondylodiscitis
?i?dem Atan,ümit Se?kin,Hatice Bodur
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2008,
Abstract: Spondylodiscitis is a well recognized but uncommon complication of Ankylosing Spondylitis (AS). It usually occurs in advanced stages of AS. The clinical presentation of spondylodiscitis may vary from asymptomatic to symptoms of serious spinal cord injury. Here we presented a case with chronic low back pain who was not diagnosed as AS earlier and who had wide-spread spondylodiscitis when diagnosed. Turk J Phys Med Rehab 2008;54:77-8
Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis  [cached]
Sawacha Zimi,Carraro Elena,Del Din Silvia,Guiotto Annamaria
Journal of NeuroEngineering and Rehabilitation , 2012, DOI: 10.1186/1743-0003-9-63
Abstract: Background Ankylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum. The dorsal hyperkyphosis may induce the patients to stand in a stooped position with consequent restriction in patients’ daily living activities. The aim of this study was to develop a method for quantitatively and objectively assessing both balance and posture and their mutual relationship in ankylosing spondylitis subjects. Methods The data of 12 healthy and 12 ankylosing spondylitis subjects (treated with anti-TNF-α stabilized), with a mean age of 51.42 and 49.42 years; mean BMI of 23.08 and 25.44 kg/m2 were collected. Subjects underwent a morphological examination of the spinal mobility by means of a pocket compass needle goniometer, together with an evaluation of both spinal and hip mobility (Bath Ankylosing Spondylitis Metrology Index), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index). Quantitative evaluation of kinematics and balance were performed through a six cameras stereophotogrammetric system and a force plate. Kinematic models together with a test for evaluating balance in different eye level conditions were developed. Head protrusion, trunk flexion-extension, pelvic tilt, hip-knee-ankle flexion-extension were evaluated during Romberg Test, together with centre of pressure parameters. Results Each subject was able to accomplish the required task. Subjects’ were comparable for demographic parameters. A significant increment was observed in ankylosing spondylitis subjects for knee joint angle with the target placed at each eye level on both sides (p < 0.042). When considering the pelvic tilt angle a statistically significant reduction was found with the target placed respectively at 10° (p = 0.034) and at 30° (p = 0.019) less than eye level. Furthermore in ankylosing spondylitis subjects both hip (p = 0.048) and ankle (p = 0.029) joints angles differs significantly. When considering the posturographic parameters significant differences were observed for ellipse, center of pressure path and mean velocity (p < 0.04). Goniometric evaluation revealed significant increment of thoracic kyphosis reduction of cervical and lumbar range of motion compared to healthy subjects. Conclusions Our findings confirm the need to investigate both balance and posture in ankylosing spondylitis subjects. This methodology could help clinicians to plan rehabilitation treatments.
The relationship between inflammation and new bone formation in patients with ankylosing spondylitis
Xenofon Baraliakos, Joachim Listing, Martin Rudwaleit, Joachim Sieper, Juergen Braun
Arthritis Research & Therapy , 2008, DOI: 10.1186/ar2496
Abstract: Spinal magnetic resonance images and conventional radiographs from 39 ankylosing spondylitis patients treated with anti-tumour necrosis factor (anti-TNF) agents at baseline and after 2 years were analysed for syndesmophyte formation at vertebral edges with or without inflammatory lesions at baseline.Overall, 922 vertebral edges at the cervical and lumbar spine were analysed. At baseline, the proportion of vertebral edges with and without inflammation (magnetic resonance imaging) that showed structural changes (conventional radiographs) was similar (in total, 16.6% of all vertebral edges in 71.4% of patients). From the perspective of syndesmophyte formation (n = 26, 2.9%) after 2 years, there were more vertebral edges without (62%) than with (38%) inflammation at baseline (P = 0.03). From the perspective of spinal inflammation at baseline (n = 153 vertebral edges), more syndesmophytes developed at vertebral edges with (6.5%) than without (2.1%) inflammation (P = 0.002, odds ratio 3.3, 95% confidence interval 1.5 to 7.4). Inflammation persisted in 31% of the initially inflamed vertebral edges (n = 132), and new lesions developed in 8% of the vertebral edges without inflammation at baseline (n = 410). From the perspective of spinal inflammation after 2 years (n = 72 vertebral edges), 5.6% of the vertebral edges showed syndesmophyte development in contrast to 1.9% of the vertebral edges with new syndesmophytes without inflammation (P = 0.06).These findings obtained in patients treated with anti-TNF agents suggest linkage and some dissociation of inflammation and new bone formation in ankylosing spondylitis. Although syndesmophytes were also found to develop at sites where no inflammation had been seen by magnetic resonance imaging at baseline, it was more likely that syndesmophytes developed in inflamed vertebral edges. More effective suppression of spinal inflammation may be required to inhibit structural damage in ankylosing spondylitis.Ankylosing spondylitis (AS) is
Andersson Lesion in Ankylosing Spondylitis
Manimegalai N, KrishnanKutty K, Panchapakesa Rajendran C, Rukmangatharajan S, Rajeswari S
JK Science : Journal of Medical Education & Research , 2004,
Abstract: Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosingspondylitis. We report three cases of ankylosing spondylitis with such lesions. These lesions simulatean infection and in our country, mimic spinal tuberculosis.
Surgical outcome after spinal fractures in patients with ankylosing spondylitis
George Sapkas, Konstantinos Kateros, Stamatios A Papadakis, Spyros Galanakos, Emmanuel Brilakis, George Machairas, Pavlos Katonis
BMC Musculoskeletal Disorders , 2009, DOI: 10.1186/1471-2474-10-96
Abstract: The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned.Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge.Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries.Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed.The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't alwa
Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine  [cached]
Raval Chetankumar,Patel Heena,Patel Pranoti,Kharod Utpala
Saudi Journal of Anaesthesia , 2010,
Abstract: Ankylosing spondylitis (AS) patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed.
Cardiopulmonary Manifestations of Ankylosing Spondylitis  [PDF]
Mahnaz Momeni,Nora Taylor,Mahsa Tehrani
International Journal of Rheumatology , 2011, DOI: 10.1155/2011/728471
Abstract: Ankylosing spondylitis is a chronic inflammatory condition that usually affects young men. Cardiac dysfunction and pulmonary disease are well-known and commonly reported extra-articular manifestation, associated with ankylosing spondylitis (AS). AS has also been reported to be specifically associated with aortitis, aortic valve diseases, conduction disturbances, cardiomyopathy and ischemic heart disease. The pulmonary manifestations of the disease include fibrosis of the upper lobes, interstitial lung disease, ventilatory impairment due to chest wall restriction, sleep apnea, and spontaneous pneumothorax. They are many reports detailing pathophysiology, hypothesized mechanisms leading to these derangements, and estimated prevalence of such findings in the AS populations. At this time, there are no clear guidelines regarding a stepwise approach to screen these patients for cardiovascular and pulmonary complications. 1. Cardiac Manifestations of Ankylosing Spondylitis Introduction Ankylosing spondylitis is a chronic and inflammatory condition, affecting the spine, sacroiliac, and peripheral joints. This entity most often affects young men and may lead to spinal vertebral fusion. Human leukocyte antigen (HLA)-B27 is present in the majority of patients with AS and is reported to contribute to the pathophysiologic manifestations of this condition [1]. It has been estimated that cardiac manifestations in patients with AS are found in 2–10% of patients. It was initially in the 1930s when aortitis found in a group of patients with spondylitis. It is widely accepted today that not only is aortic pathology linked to AS, but there is also risk for conduction defects, valvular regurgitation, and cardiomyopathy, associated with this entity [1]. This is especially important, given that in many patients, cardiac changes may begin prior to the onset of clinical symptoms [2, 3]. 1.1. Valvular Disease The presence of aortic root and valve disease in ankylosing spondylitis is related to the duration of the underlying disease. Aortic disease and aortic regurgitation may, however, predate the onset of any joint symptoms, and the presence of ankylosing spondylitis as an underlying cause may not be initially appreciated [1]. One of the first pathophysiologic descriptions of valvular disease in AS was put forward by Bulkley and Roberts, who studied autopsy findings in eight patients with AS. They noted aortic root dilatation along with fibrous proliferation along the intima [4]. Further examination demonstrated a cellular inflammatory process coupled with platelet aggregation
Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report  [cached]
Bartanusz Viktor,Ziu Mateo,Wood Leisha E,Caron Jean-Louis
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-314
Abstract: Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.
Priyanka Lokwani*,Yozana Upadhyay,Pramod Kumar,Stuti Gupta
Pharmacie Globale : International Journal of Comprehensive Pharmacy , 2011,
Abstract: Ankylosing spondylitis (AS) is a chronic, progressive, connective tissue disorder that is characterized by inflammation of the joints of the spine (vertebral joints), hipbones, and sacrum (sacroiliac joints). There is no cure for ankylosing spondylitis, but treatments can decrease pain and lessen symptoms. Treatment includes pain relieving drugs, DMARDs and TNFα blockers; herbal and homeopathic medications are also available.
Spinal instability in ankylosing spondylitis  [cached]
Badve Siddharth,Bhojraj Shekhar,Nene Abhay,Varma Raghuprasad
Indian Journal of Orthopaedics , 2010,
Abstract: Background: Unstable spinal lesions in patients with ankylosing spondylitis are common and have a high incidence of associated neurological deficit. The evolution and presentation of these lesions is unclear and the management strategies can be confusing. We present retrospective analysis of the cases of ankylosing spondylitis developing spinal instability either due to spondylodiscitis or fractures for mechanisms of injury, presentations, management strategies and outcome. Materials and Methods: In a retrospective analysis of 16 cases of ankylosing spondylitis, treated surgically for unstable spinal lesions over a period of 12 years (1995-2007); 87.5% (n=14) patients had low energy (no obvious/trivial) trauma while 12.5% (n=2) patients sustained high energy trauma. The most common presentation was pain associated with neurological deficit. The surgical indications included neurological deficit, chronic pain due to instability and progressive deformity. All patients were treated surgically with anterior surgery in 18.8% (n=3) patients, posterior in 56.2% (n=9) patients and combined approach in 25% (n=4) patients. Instrumented fusion was carried out in 87.5% (n=14) patients. Average surgical duration was 3.84 (Range 2-7.5) hours, blood loss 765.6 (± 472.5) ml and follow-up 54.5 (Range 18-54) months. The patients were evaluated for pain score, Frankel neurological grading, deformity progression and radiological fusion. One patient died of medical complications a week following surgery. Results: Intra-operative adverse events like dural tears and inadequate deformity correction occurred in 18.7% (n=3) patients (Cases 6, 7 and 8) which could be managed conservatively. There was a significant improvement in the Visual analogue score for pain from a pre-surgical median of 8 to post-surgical median of 2 (P=0.001), while the neurological status improved in 90% (n=9) patients among those with preoperative neurological deficit who could be followed-up (n =10). Frankel grading improved from C to E in 31.25% (n=5) patients, D to E in 12.5% (n=2) and B to D in 12.5% (n=2), while it remained unchanged in the remaining - E in 31.25% (n=5), B in 6.25% (n=1) and D in 6.25% (n=1). Fusion occurred in 11 (68.7%) patients, while 12.5% (n=2) had pseudoarthrosis and 12.5% (n=2) patients had evidence of inadequate fusion. 68.7% (n=11) patients regained their pre-injury functional status, with no spine related complaints and 25% (n=4) patients had complaints like chronic back pain and deformity progression. In one patient (6.2%) who died of medical complications a week followin
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