Ankylosing Spondylitis Remission
Fig. 8.44a The right iliosacral joint is already fused in its lower part. The left iliosacral joint shows pronounced periarticular sclerosis along erosions of the bone (arrow). This is a rather typical pattern of ankylosing spondylitis. b In the final phase and with maximal expression of Bechterew disease (as ankylosing spondylitis is also called), the paraspinous ligaments become ossified, giving rise to the so-called bamboo spine. The intervertebral spaces are completely bridged by ossified tissue, which reduces the flexibility of the spine to nil. Any deceleration trauma may have dire consequences in this setting. Fig. 8.44a The right iliosacral joint is already fused in its lower part. The left iliosacral joint shows pronounced periarticular sclerosis along erosions of the bone (arrow). This is a rather typical pattern of ankylosing spondylitis. b In the final phase and with maximal expression of Bechterew disease (as ankylosing spondylitis is also called), the paraspinous...
More than 30 of skeletal TB cases involve the spine (tuberculous spondylitis or Pott's disease). The most commonly affected area is the lower thoracic spine, followed by the lumbar, cervical, and sacral areas. The mode of spread to the spine is usually hematogenous, but it also can result from contiguous disease or lymphatic spread from TB pleuritis. In contrast to common bacterial causes of spinal osteomyelitis that initially present as discitis with adjacent vertebral body involvement, TB spondylitis typically begins within the anterior vertebral body. With time, spread to the adjacent disc and vertebra occurs, and vertebral body wedging develops. A 12-month course of treatment is recommended for Pott's spondylitis. In a review of uncomplicated cases, response rates to systemic chemotherapy and bed rest until pain
Inflammatory disorders to consider are juvenile ankylosing spondylitis and spinal osteochondritis (Scheuermann's disorder), which may affect adolescent males in the lower thoracic spine (around T9) and thoracolumbar spine. The latter condition may be asymptomatic, but can be associated with back pain, especially as the patient grows older. It is the commonest cause of kyphosis. It is important to screen adolescent children for idiopathic scoliosis, which may be without associated backache.
The significant correlation between high proportions of CD8+CD28 T cells and poor antibody response to influenza vaccination documented in two independent clinical studies (Goronzy et al., 2001 Saurwein-Teissl et al., 2002) provides an example of putative suppressive effects of senescent CD8+ T cells on the function of other immune cells. Senescent CD8+ T cells have also been associated with suppressive effects in organ transplant patients. Donor-specific CD8+CD28 T cells are detectable in the peripheral blood of those patients with stable function of heart, liver and kidney transplants, whereas no such cells were found in patients undergoing acute rejection (Cortesini et al., 2001). Although in the context of organ transplantation, suppression may lead to a favorable outcome, in many other contexts, the CD8+CD28 T cell populations are associated with deleterious effects. For example, expanded populations of CD8+CD28 T cells are present in ankylosing spondylitis patients, and, in...
Tiwari and Terasaki's book published in 1985 (Tiwari and Terasaki, 1985), listed hundreds of HLA-associated diseases, even though the first demonstration of a strong association, that of HLA-B27 and ankylosing spondylitis (AS), came only a decade earlier. Meanwhile, many more associations have been added to the list but, apart from Narcolepsy, which shows an almost absolute association with DQB1*0602, none have been as strong as the association of HLA-B27 with AS (Lechler and Warrens, 2000). There are conflicting reports for many of the weaker associations, which include everything from aging and dyslexia to autism and sleepwalking (Lecendreux et al., 2003). In some of these studies insufficient numbers of cases and controls were examined to obtain
A Ankylosing spondylitis a Ankylosing spondylitis Fig. 14.18a In ankylosing spondylitis, also called Bech-terew disease, slowly progressive ossification of the complete ligamentous apparatus of the spinal column occurs. You have already seen the prototypical appearance of the bamboo spine in Fig. 8.44b, p. 146. Note the fracture at the C6 7 level after a minor trauma in this patient. b In Forestier disease only the anterior longitudinal ligament of the spinal column ossifies, but the effect is the same the spine loses all its elasticity. Every motion that results in any significant axial loading force on the spine constitutes a considerable fracture risk for these patients. Minor trauma has led to a fracture of the C7 in this case.
Vertebrae We prepare a sagittal saw section through the center of a vertebra after the anterior half of the spinal column has been removed for exposure of the spinal cord. Intervertebral disk tissue should be part of the slice selected for histologic study, particularly in the presence of degenerative diseases, ochronosis, or ankylosing spondylitis. In this latter condition, costovertebral and costotransverse joints should be included.
MDS cases are reported in cohorts of individuals exposed to radiation, for treatment of diseases such as ankylosing spondylitis (Brown and Doll 1965), or following exposure to the A-bomb in Hiroshima and Nagasaki (Matsuo et al. 1988). Some of these cases occurred up to 40 years after exposure and thus the precise association
Wladimir von Bechterew was a neurologist and psychiatrist in St. Petersburg around 1900. His psychiatric ideas and models were highly speculative, but his neuroanatomical scientific work is relevant to this day. He was one of the first to comprehensively describe ankylosing spondylitis. One of his colleagues and major rivals in St. Petersburg was Ivan Pavlov, whose experiments we all know. In 1927 the leader of the Soviet Union, a certain Comrade Stalin, sought his medical advice. The 70-year-old Bechterew diagnosed a grave paranoia and did not hesitate to tell the dictator. Bechterew survived the diagnosis by a whole day. The radiograph of the lumbar spine can allow diagnosis of osteochondrosis, malalignment, instability, spondylolysis and ankylosing spondylitis. It should always be the first imaging modality to be used in back pain.