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Condition/Disorder Synonyms

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  • Pott's disease

  • Bekhterev syndrome

  • Marie-Strümpell disease

  • Rheumatoid spondylitis

  • Ankylosing spondylitis

  • Spondyloarthropathy

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ICD-9-CM Code

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  • 720.81 Inflammatory spondylopathies in diseases classified elsewhere

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ICD-10-CM Code

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  • M49.80 Spondylopathy in diseases classified elsewhere, site unspecified

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Preferred Practice Patterns

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Key Features

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Description

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  • Inflammation of one or more spinal vertebrae

  • Can be localized due to infection of a certain spinal area, degenerative arthritis, or following a traumatic injury

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Essentials of Diagnosis

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  • Most characterized with sacroiliac (SI) joint pain and dysfunction

  • Etiology unknown

  • Acute, painful flare-ups

  • Chronic, persistent pain

  • Pain for longer than three months

  • Relief with NSAIDs

  • Morning stiffness

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General Considerations

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  • Begins with intermittent low back pain

  • Improved with low-level activity

  • May have rapid and severe onset

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Demographics

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  • Begins after age 40, though onset can be earlier due to trauma or infection

  • Can affect any age or gender

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Clinical Findings

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Signs and Symptoms

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  • Loss of ROM and joint play

  • Intermittent back pain

  • Heel pain

  • Hip pain and stiffness

  • Joint pain and swelling in shoulders, knees, ankles

  • Thoracic and pulmonary involvement

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Functional Implications

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  • Limited mobility

  • Aerobic endurance limitation

  • May impede ability to perform ADLs/IADLs

  • May impede participation in sports and other social activities

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Possible Contributing Causes

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  • Trauma

  • Occupational factors

  • Congenital anomalies

  • Physical condition

  • Smoking

  • Obesity

  • Socio-economic factors

  • Psychosocial and behavioral factors

  • Postural changes

  • Weakness of core musculature

  • Tightness of hip flexors, hip external rotators, hamstrings

  • Degenerative arthritis

  • Gastrointestinal infections

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Differential Diagnosis

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  • Ankylosing spondylitis

  • Spinal stenosis

  • Disc herniation

  • Crohn's disease

  • Forestier's disease

  • Reiter's syndrome (reactive arthritis)

  • Whipple's disease

  • Systemic auto-immune diseases (rheumatoid arthritis, Reiter's syndrome)

  • Spondylosis

  • Spondylitis

  • Spondylolisthesis

  • Spinal alignment

  • Sacral dysfunction

  • Erector spinae muscle strain

  • Myofascial pain syndrome

  • Yersinia arthritis

  • Facet joint arthritis

  • Psoriatic arthritis

  • Rheumatoid arthritis

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • To rule out systemic disease, differential diagnosis

    • Complete blood count (CBC)

    • Erythrocyte sedimentation rate (ESR)

    • HLA-B27 antigen, genetic marker for ankylosing spondylitis

    • No single blood test can determine spondylitis

    • Negative serologic tests for rheumatoid factor

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Imaging

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  • MRI helpful in diagnosis to visualize structure of ligament, compressed or inflamed nerve root, disc pathology

  • X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)

  • CT to show structure ...

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