eMedicine Specialties > Neurology > Inflammatory and Demyelinating Diseases

Ankylosing Spondylitis: Follow-up

Author: Alan Schaffert, MD, Former Chief of Staff, Department of Medicine, Doctor's Medical Center of Modesto; Clinical Assistant Professor, University of California at Davis
Contributor Information and Disclosures

Updated: Jan 8, 2007

Follow-up

Complications

  • Atlantoaxial subluxation may occur spontaneously and can be associated with a severe myelopathy. It is found in about 20% of patients who have a mean disease duration of 10 years. Clinically significant myelopathy requiring fusion is found in only 2%.
  • Cervical spinal fractures are uncommon and usually are seen in patients with advanced disease.
    • Fracture usually results from minor trauma. Typically, the fracture is through the intervertebral space at level C5-C6 or C6-C7. Neurological deficits associated with spinal fracture may be delayed for 2-30 days.
    • Approximately 57% have severe neurological sequelae. Overall mortality rate is 35%, about twice that of a similar fracture in healthy individuals.
  • Cervical myelopathy may result from cervical spinal stenosis.
  • Thoracic and lumbar spinal fractures are less common than cervical spinal fractures. They usually result from minor trauma and may be multiple. Severe neurological deficits are frequent.
  • Lumbar spinal stenosis may result in a cauda equina syndrome.
    • Chronic inflammatory cauda equina syndrome occurs only in long-standing AS and may occur when other aspects of the disease are seemingly inactive.
    • Patient described a gradual onset of buttock and leg pain. Sensory symptoms are often mild and symmetrical, often not noticed by the patient.
    • Motor involvement and bowel or bladder dysfunction are variable.
    • This condition is slowly progressive to stable for years to decades.
    • Neither surgery nor steroid therapy is beneficial.
  • Radiculopathies may occur as a result of foraminal stenosis, disc disease, or fracture at the level of a nerve root.

Prognosis

  • Symptoms of pain and stiffness are common and may be moderately severe to severe. Patients have few problems with social interactions, although depression is common.
  • Most patients remain employed and relatively few develop severe functional disability. Disability correlates with duration of disease, disease activity, and spinal mobility. Peripheral joint involvement also results in greater impairment.
  • The medical cost of treating AS can be relatively low compared with the costs of other rheumatologic diseases. The use of tumor necrosis factor antagonist agents is very expensive.

Miscellaneous

Medicolegal Pitfalls

  • Angular kyphosis may result from a spinal fracture. Evaluation often requires imaging techniques, since neurological deficits may be delayed.
  • Nocturnal pain in a weight-bearing joint is atypical and should be evaluated.
  • Persistent neck or back pain after a seemingly minor trauma requires evaluation to rule out a fracture. Multiple fractures are a possibility, which may be difficult to see on a plain x-ray. Obtain CT or MRI scans and image the spine liberally to avoid missing an occult fracture.
  • With preexisting kyphosis, a suspected thoracolumbar fracture may be a contraindication to immobilization in the supine position. Severe neurological deficit may result.
 


More on Ankylosing Spondylitis

Overview: Ankylosing Spondylitis
Differential Diagnoses & Workup: Ankylosing Spondylitis
Treatment & Medication: Ankylosing Spondylitis
Follow-up: Ankylosing Spondylitis
References
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References

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Further Reading

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Keywords

ankylosing spondylitis, Marie-Strümpell arthritis, Bechterew disease, spondyloarthritis, spondyloarthropathy, chronic inflammatory conditions, AS, inflammation of the joints, inflammation of the tendons, inflammation of the ligaments, iritis, uveitis, aortitis, pulmonary fibrosis, amyloidosis, inflammatory bowel disease

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Contributor Information and Disclosures

Author

Alan Schaffert, MD, Former Chief of Staff, Department of Medicine, Doctor's Medical Center of Modesto; Clinical Assistant Professor, University of California at Davis
Alan Schaffert, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, California Medical Association, and National Stroke Association
Disclosure: Nothing to disclose.

Medical Editor

Rodrigo O Kuljis, MD, Esther Lichtenstein Professor of Psychiatry and Neurology, Director, Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Miami School of Medicine
Rodrigo O Kuljis, MD is a member of the following medical societies: American Academy of Neurology and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Associate Program Director, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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