Spine Questions

Question 1

Ankylosing Spondylitis

Answer 1

Aetiology: primary or associated with psoriasis / IBD

5 males: 1 female (usually severe)

Presents in 20s

Strong associations with HLA-B27

Question 2

X-ray findings

Answer 2

Sacroiliitis
Bamboo spine:
Squaring of vertebrae
Disc ossification
Spinal fusion

Question 3

Associated features

Answer 3

Uveitis

Peripheral enthesitis in 33% (especially Achilles tendonitis)

Question 4

Management

Answer 4

Simple analgesia
NSAIDs
Anti-TNF therapy where NSAIDs fail

Question 5

Lumbar back pain

Answer 5

Mechanical: muscular, disc prolapse, OA, #, spondyloisthesis (vertebral ‘slipping’), spinal stenosis

Inflammatory: ankylosing spondylitis

Other serious pathology: bone metastases, myeloma, TB, osteomyelitis

Question 6

Neurogenic claudication

Answer 6

Due to spinal stenosis (lumbosacral OA with narrowing of bony foramina & nerve root impingement)
Calf / buttock / thigh discomfort when walking
Classically relieved by bending forwards at waist (spinal flexion opens up bony foramina)
This feature is useful in differentiating from intermittent (vascular) claudication