Spondylitis

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

• 720.81 Inflammatory spondylopathies in diseases classified elsewhere

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

• 4B: Impaired posture1
• 4E: Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation2
• 4F: Impaired joint mobility, motor function, muscle performance, range of motion, and reflex integrity associated with spinal disorders3

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• Begins with intermittent low back pain
• Improved with low-level activity
• May have rapid and severe onset
  • Secondary problems
    • Pulmonary fibrosis
    • Restrictive lung capacity

Demographics

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

Signs and Symptoms

• 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

Functional Implications

• Limited mobility
• Aerobic endurance limitation
• May impede ability to perform ADLs/IADLs
• May impede participation in sports and other social activities

Possible Contributing Causes

• 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

Differential Diagnosis

• 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

Laboratory Tests

• 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

Imaging

• 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
...