Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located at the base of the low back where the sacrum. Chronic inflammation in these areas causes pain and stiffness in and around the spine, including the neck, middle back, lower back, and buttocks. Over time, chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis.
It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27.
These fused spines are particularly brittle and vulnerable to breakage (fracture) when involved in trauma. Chronic spondylitis and ankylosis cause forward curvature of the upper torso (thoracic spine), which limits breathing capacity. Spondylitis can also affect the areas where ribs attach to the upper spine, further limiting lung capacity.
Physical therapy for ankylosing spondylitis includes instructions and exercises to maintain proper posture. This includes deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Physical therapists customize exercise programs for each individual. Swimming often can be a very beneficial form of exercise, as it avoids jarring impact of the spine.
Following advise are usually given by doctors:
- Learning correct body mechanics to maintain erect posture that counteracts the affects of kyphosis (the forward curve of the spine)
- Not using a pillow when you sleep, again to help prevent kyphosis
- Doing regular non-jarring exercises, such as swimming
- Maintaining high levels of activity
- Doing daily stretching exercises and deep breathing (for lung expansion)
- Avoiding prolonged bed rest and sitting
When is surgery required?
Surgery is necessary if the disease has led to severe spinal deformity , such as extreme kyphosis that prevents standing and looking forward. In this case, a spinal osteotomy might be considered. This operation involves cutting through the spinal bones and realigning them into a position that allows the patient to stand and look forward.
Surgery may also be recommended if the hip joints have been affected by the arthritis associated with AS. If the hips become severely damaged by arthritis, an artificial total hip replacement may be required. This is a fairly common surgical procedure for patients with AS.