Spinal Inflammatory Disorders
Inflammatory disorders of the spine can be caused by a wide range of conditions, including arthritis, osteoporosis, and infection. Inflammation in the spine is rare but can be a significant source of pain and disability, especially if these hard-to-diagnose conditions go untreated.
- Ankylosing spondylitis, a form of arthritis in the spine, is one of the most common spinal inflammatory disorders. Other sources of spinal inflammation include
- Arachnoiditis, an infection of the membrane that surrounds the spinal cord;
- Discitis, an infection in the space in between vertebrae;
- Sacroiliitis, inflammation of the joint between the lower back and the pelvis; and
Ankylosing spondylitis involves inflammation in the areas where soft tissue (ligaments and tendons) attaches to bone. Beginning in the lower back and the joint between the spine and the pelvis, the inflammation causes some of the tissue to erode, and when the inflammation subsides, new bone may grow in its place. This progressive cycle of bony growth restricts movement and may result in complete fusion between two bones.
In patients with an infection, the cause of the inflammation is obvious. The origin of ankylosing spondylitis is unknown, although it is known to have a genetic component.
Patients with spinal inflammation will experience back pain in some form. Those with infections, for example, may experience a slow onset of severe back pain, accompanied by fever, chills, and fatigue. Patients with ankylosing spondylitis experience slow-onset pain as well, but it may come and go. This pain usually is more severe at night and is associated with stiffness in the morning. Ankylosing spondylitis also causes a stiff, stooped posture and the pain and swelling may move to other joints. The heart, lungs, and eyes also may be affected.
Diagnosis of inflammatory disorders of the spine often begins with a full physical examination and blood tests that can identify an infection or detect the presence of inflammation. X-rays also are used to visualize the changes in the spine and identify bony growths. Finally, patients with ankylosing spondylitis may undergo genetic testing; a certain gene (HLA-B27) has been found to be present in 90 percent of patients with ankylosing spondylitis.
Treatment of an inflammatory disorder of the spine varies depending on the cause of the inflammation. If an infection is identified, antibiotics, rest, and a brace may be used. In patients with ankylosing spondylitis, anti-inflammatory medications and muscle relaxants often are given to control pain so patients can exercise and improve posture. In some cases, surgery may be necessary. Usually surgery is conducted to remove bony growths and alleviate pressure on painful joints. A small percentage of these patients may need a hip joint replacement.