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  • Pott’s disease
  • Bekhterev syndrome
  • Marie-Strümpell disease
  • Rheumatoid spondylitis
  • Ankylosing spondylitis
  • Spondyloarthropathy

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  • 720.81 Inflammatory spondylopathies in diseases classified elsewhere

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

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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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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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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 of ligament, herniation compressing the spinal canal/nerves, or to rule out abdominal pathology
  • Electrodiagnostic/nerve conduction testing can help determine specific impaired nerve function
  • Doppler ultrasound to examine vascular function
  • Diagnostic ultrasound to analyze fiber orientation

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  • Single segmental problem
  • Multi-level “bamboo spine”: ankylosing ...

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