Ankylosing Spondylitis

Question 1

What is ankylosing spondylitis?

Answer 1

An autoimmune enthesitis that primarily affects the axial skeleton. HLA-B27+ in 90%, RH neg

Question 2

What is the diagnostic criteria for ankylosing spondylitis?

Answer 2

1) uveitis
2) bilateral sacroiliitis
3) HLA-B27+

Question 3

What fracture is common in patients with ankylosing spondylitis?

Answer 3

cervical fractures; can get epidural hematoma from hemorrhage
Will need longer fusion constructs d/t lever arm of diseased spine

Question 4

What is the general medical treatment for ankylosing spondylitis?

Answer 4

1) NSAIDs and PT

2) TNF-alpha blockers (infliximab, enteracept, adalimumab

Question 5

What surgical options are available to correct the deformity a/w ankylosing spondylitis?

Answer 5

1) Lumbar wedge osteotomy; three column wedge removed with anterior hinge, can restore lordosis, corrects 35-40° per level
2) C7-T1; corrects chin-to-chest kyphosis;

Question 6

THA in patients with ankylosing spondylitis is at increased risk for what complication?

Answer 6

anterior dislocation; d/t vertical and anteverted orientation of acetabulum