Neuro Disorders: Bamboo Spine

What is it?

Bamboo spine is the other name for Ankylosing Spondylitis, a systemic inflammatory condition that predominantly affects the lower spine and pelvic bones (sacroiliac joint).

It is the characteristic x-ray appearance of the spine that gave the name for this disease as bamboo-spine.

Who gets this disease?

It can affect any race or ethnicity. Men are affected little more than women. The disease process begins in early adulthood then slowly progresses.

Ankylosing spondylytis is an immune mediated inflammatory condition. It is a chronic disease. It is also a systemic disease because it can affect various organs and tissues in the body other than the joints. Also other joints like knee, hip etc may be involved too but definitely less common as compare to the spine & pelvis involvement.

The other organs or tissues that may be affected include the eyes, heart, lungs, aorta etc.

How does patient present?

This is most often a slowly progressive chronic disease. So the majority of the early symptoms are mild and generally attributed to some muscle strain etc. Patients start experiencing lower back pain and pain in the pelvic area (corresponding to sacroiliac joint) associated with muscle stiffness. These symptoms maybe more severe with rest and may get better during physical activities.

If other organs like heart, lungs etc are involved then patient will have manifestations related to these organs. Eye inflammation is common so reddening of eyes, pain in the eyes, decreased or loss of vision is seen too.

As disease progresses the patient assumes a peculiar position due to fusion and inflexibility of the spine. There will be more and more limitation of movements due to fusion of the joints.

Diagnosis

In the later stages the clinical presentation is characteristic due to the fusion and inflexibility of the spine.

The following investigations are commonly obtained;

• X-Ray of spine and sacroiliac joint
• Blood tests like ESR/CRP, ANA, RA factor
• CT or MRI of spine and sacroiliac joint
• HLA B27 genetic test etc.

The x-ray findings of fusion of the vertebrae and sacroiliac joints, usually giving rise to a bamboo spine like appearance is characteristic for this disease. In the early stage CT or MRI may be necessary as x-ray may not pick the disease at this stage. Elevate ESR and/or CRP indicate an underlying inflammatory process.

HLA B27 is positive in about 90 to 95% of these patients however it is not specific for this condition.

Treatment

There is no curative treatment for bamboo spine disease now, so the treatment is symptomatic & supportive and includes;

• Pain medications
• Muscle relaxants
• Physical therapy etc.

Disease modifying agents like methotrexate, cyclosporine, tumor necrosis factor alpha blockers infliximab may help in reducing the inflammation and slowing down the progression of the disease however they do not eliminate the disease. When these agents are taken on a long term, basis there may be serious are side effects too.

Some sort of surgical interventions like joint replacements, corrective surgeries etc may be needed in later stages.

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