- Uncertain cause but associated with the HLA-B27 gene.
- More common in men. Usually presents in the 20-30 years age group.
- Early diagnosis is important if irreversible spinal changes are to be avoided.
- Morning stiffness for more than 30 minutes.
- Sleep disturbed by back pain. Pain improves with exercise.
- Pain in the sacroiliac joints.
- No associated sciatic pain and normal straight leg raising test.
- Chest expansion reduced.
- Thoracic kyphosis and loss of spinal flexion.
- Refer for X-ray of spine and sacroiliac joints.
- ESR may be raised and may have normochromic anaemia.
- Check for HLA-B27.
- TNF blockers (etanercept and adalimumab) and NSAIDs.
Pott disease (Tuberculous spondylitis)
- Spinal TB usually involving one or more vertebrae.
- Most commonly affects thoracic and lumbosacral spine.
- Rare in the UK but common in developing countries and those with HIV.
- Back pain and radicular pain occur early.
- Fever and weight loss.
- Neurological damage presenting with paraplegia, nerve root pain, paraesthesia.
- If cervical region involved may also suffer dysphagia, stridor and torticollis.
- Complications are paraplegia and abscesses of paraspinal tissue and sinus tracts.
- CT scan and MRI to assess disc space infection and soft tissue.
- Immobilise spine for two to three months.
- Antituberculous therapy.
- Isoniazid and rifampicin for nine to 12 months and two additional drugs for first two months: ethambutol or pyrazinamide.
- Surgery to relieve compression and drain pus.