FAQ Category: General Spine

Any kind of graded exercise means you’ll start out slowly and gradually increase the frequency, intensity, and duration of any exercises given. With a spine fracture, this often takes the form of spinal stabilization exercises that include the entire trunk (back and abdomen). Most rehab programs are designed, administered, and/or supervised by a physical therapist.

In order to stabilize anything with exercise, the first step is an isometric muscle contraction. That means you will learn how to contract various individual and groups of muscles but without moving the spine. Isometric exercise allows you to tone and strengthen muscles without disrupting the healing bone.

The next step in the progression is isotonic exercises. Now you are contracting the muscles with the intent of moving some body part(s). That could mean moving the trunk in various directions (flexion, extension, rotation). The range-of-motion may be limited during this phase according to how much healing has already taken place, how stable the frature is, and the general condition of the person.

Eventually (and usually as you get closer to the time when full bone healing is anticipated — typically, in six to eight weeks time), the exercise program becomes more functional. Now specific exercises are added to help prepare your back for the kind of conditions you might experience at work. If you sit all day at a desk in front of a computer, your occupation-specific exercises will likely be different compared with a worker with the same injury who lifts 50-pound bags, shovels grain, works construction, or even bags groceries at a store.

The therapist may use a wide range of different approaches such as Pilates, plyometrics, or bioergonomics to restore your flexibilty, mobility,strength, power, endurance, stability, and agility. Here again, the therapist will design the program for your individual needs.

Whenever possible, there is a home program portion of the rheab protocol. The more you can do at home (unsupervised), the faster your recovery will be. And there’s a certain cost savings for anyone with a back injury who can complete a daily program of exercise on his/her own without constant supervision. Although you are unsupervised on a daily basis, the therapist will recheck your progress and the program weekly and make any changes needed.

Surgical fusion of the spine for degenerative disease is becoming a popular way to treat this problem. And that’s because surgeons now have at their disposal better ways to perform the surgery and improved hardware such as pedicle screws and locking plates to hold the bones together. Bone graft is also a commonly used material to help get a solid fusion.

Bone grafts can be taken from a bone bank (donated by someone else). This type is called an allograft. Allograft is not osteoinductive or osteogenic. That means it doesn’t cause the body to produce more bone, nor does it produce bone itself. In that sense, it can be considered dead. It just gives a scaffold or place for the patient’s body to fill in with bone produced during the healing phase.

That’s considered one of the disadvantages of allograft versus autograft bone. The up side is that there are no problems at the donor site with pain, infection, or poor wound healing. Autograft (bone taken from the patient) is still alive and capable of producing more bone cells. That’s a benefit as the body fills in the fusion site faster. But then there’s the risk of donor site morbidity (problems) as described.

Sometimes the surgeon uses bone graft material along with metal plating or a device called a cage. Plating anteriorly (from the front of the neck) is usually advised when there are multiple levels being fused. Cages have been made of titanium for the most part. The surgeon fills the cage with bone graft material to help boost the process of spinal fusion. Newer implants made of plastic or porous tantalum are being tried in hopes that fusion rates can be improved with better bone in-growth.

Pseudarthrosis is another word for false joint and refers to movement that occurs at the fused site. It can occur without symptoms so the patient doesn’t even know he or she has it. Or it can cause back and leg (or arm) pain, depending on whether the fusion is at the cervical (neck) or lumbar (low back) level.

There can be many causes of failed spinal fusion such as the hardware coming loose or infection and poor wound healing. Pseudarthrosis occurs as a result poor health from smoking, diabetes, and/or heart disease. It accounts for almost one-fourth of all revision fusion surgeries.
Patients who do not follow the guidelines for movement restriction during the post-operative period are also at risk of failed fusion.

How does the physician diagnose pseudarthrosis? It can be discovered in the patient who doesn’t have any real symptoms when dynamic imaging studies are done. Dynamic means the X-rays are taken as the patient is moving. But this method isn’t very reliable and wouldn’t be done routinely after surgery if the patient wasn’t having any problems.

When it comes to diagnostic imaging, there just isn’t a good way to tell if the fusion failed. When reading dynamic radiographs, the radiologist knows that just because there isn’t any obvious motion doesn’t mean the fusion is complete. And just how much motion constitutes a failed fusion remains fuzzy. There’s a lot of debate about what is and what isn’t a solid fusion. Some experts think there’s a difference in springiness between a fusion with and without hardware to hold it together during the healing phase.

Thin-slice CT scans have been used to assess the fusion site. But the results don’t really add anything more than what is seen on the X-rays. The one exception to this is in the case of locked pseudoarthrosis. Thin-cut CT scans help show this problem more clearly than dynamic radiographs. Locked pseudoarthrosis describes a situation in which the top and bottom of the cage inserted between the two vertebrae has fused solid but the middle (inside the cage) has not filled in with bone and solidified.

MRIs can be a bit iffy in patients with hardware in place because the implants cause artifacts (unexplained shadows and altered densities). Those changes interfere in judging whether or not the fusion is completed. There has been some question about the use of ultrasound and bone scans to help diagnose pseudarthrosis. Not enough study has been done to clear up any questions about these modalities. When imaging studies do not aid in the diagnosis, the surgeon can rely on a follow-up surgical procedure to confirm any diagnostic suspicions. Only patients with painful, disabling symptoms would undergo a second (diagnostic) procedure.

You are in good hands if your surgeon is routinely screening for osteoporosis and pretreating patients who might be at risk for fractures from brittle bones associated with osteoporosis. You may not be cancelled for surgery. It depends on a number of different factors. Your age, the quality of bone density, your levels of calcium and vitamin D, and your overall general health are all important factors in the decision.

Information on the quality of bones is important if your surgeon was planning to use instrumentation. Instrumentation refers to hardware such as metal plates, screws, pins, or wires to help hold the bones together until the fusion is completed. There is a risk of implant loosening and pseudoarthrosis developing in the presence of osteoporosis. Pseudoarthrosis means there is movement in the spine where the fusion is supposed to hold the vertebral bones steady without movement.

If osteoporosis is present, surgery may be postponed and rescheduled by a few weeks. Treatment to supplement vitamin D or to address the balance between bone tear down and bone build up may take a few weeks to months. But before jumping the gun and making any assumptions, get the preop tests done and have your surgeon go over the results with you. You may be worrying about something that won’t happen.

Almost one million adults in the United States suffer vertebral compression fractures (VCFs) each year. When that many people are affected by a condition, doctors and scientists take a closer look to see what can be done to improve treatment and save money.

A group of neurosurgeons from The Johns Hopkins Medical Center just published a systematic review on the treatment of vertebral compression fractures using vertebroplasty and kyphoplasty. These procedures have been around for a while now so there’s some convincing evidence that they work well.

A systematic review means they searched all the published literature for articles on the use of vertebroplasty or kyphoplasty for vertebral compression fractures. They reviewed the design of the study and the level of evidence (poor-fair-good-excellent or insufficient) and reported on the results for three different conditions: osteoporosis-, trauma-, and tumor-induced compression fractures.

A vertebroplasty is done by making a small incision in the skin on each side of the spinal column. A long needle is inserted through each opening. The surgeon slides the needles through the back of the spinal column into the fractured vertebral body.

A fluoroscope is used to guide the needles. This is a special X-ray television camera adjusted above the patient’s back that lets the surgeon see the patient’s spine on a screen. Metal objects show up clearly on X-rays. The needles are easy for the surgeon to see on the fluoroscope screen. This helps the surgeon confirm that the needles reach the correct spot.

Once the needle is in place, special acrylic bone cement is injected through the needle into the fractured vertebra. A chemical reaction in the cement causes it to harden in about 15 minutes. This fixes the bone so it can heal. Bandages are placed over the small openings where the needles were inserted.

A kyphoplasty is done with the same minimally invasive technique. But instead of a needle injecting cement into the bone, a hollow tube with a deflated balloon on the end is slid into holes drilled in the vertebrae. The balloons are inflated with air. This restores the height of the vertebral body and corrects the kyphosis (hunchback) deformity that can occur with vertebral compression fractures. Then surgeon removes the balloon and injects bone cement into the hollow space formed by the balloon. Once the cement hardens, the bone is held in its corrected height and position.

Your mother may be a good candidate for a kyphoplasty. The evidence suggests that for those who suffer back pain, this procedure reduces/eliminates that pain right away. For those who are limited by deformity, physical function and mobility are often restored. Make an appointment with her physician to discuss your concerns and this (and other) treatment options.

Experts have asked the same question: these procedures provide rapid pain relief, but is the final outcome of treatment any different or better than standard medical care? Can the cost of these procedures be justified?

A review of the studies done in this area show that in the short-term (within the first two weeks to three months) patients experience significant improvement in pain, mobility, and quality of life with a vertebroplasty (the procedure you described). No wonder because they could stand up, sleep, sit, get dressed, go shopping, take a bath and participate in their usual activities once again. But when compared with standard medical care, the results weren’t any different in the long-run (two years later).

Looking at the comparisons a little closer, there were some other benefits of vertebroplasty. Patients could use less pain medication, their general health improved in the first three months, and there were very few complications with the treatment. Patients with tumor-related compression fractures did not respond as well as patients with osteoporosis or trauma-induced fractures.

Vertebral compression fractures are painful enough that many people in the studies crossed over from standard medical care to the surgical procedure despite being assigned to the standard care group as part of the study. Seeing immediate pain relief and greater improvement in physical functioning in other patients after only 24 hours was the reason some patients insisted on crossing over.

Given those results, telling patients that standard care will have the same results as VP or KP in 12 to 24 months loses some of its punch. Although the evidence isn’t always consistently high-level, the results of this systematic review support the use of vertebroplasty. Rapid pain relief, earlier mobilization, fewer and shorter hospitalizations all add up to improved care at a reduced cost.

Interventional procedures involve a minimally invasive operation. The surgeon inserts a long needle through a tiny incision in the skin and advances it to the spine in order to carry out the procedure. This approach is called percutaneous. A special real-time X-ray called fluoroscopy is used to guide the surgeon.

Or the surgeon can make a slightly larger incision and insert a tube through which an endoscope is placed. The scope has a tiny TV camera on the end that also shows the surgeon the spine and surrounding anatomy. With the guidance offered by fluoroscopy or endoscope, the surgeon can be much more precise and accurate without making a large incision and opening the patient up.

Epidural steroids, epidural adhesiolysis, nerve blocks, radiofrequency ablation, and sacroiliac joint injections are just a few of the minimally invasive interventional treatments available. The choice of procedures depends on the cause of the problem. The surgeon will have to do some tests to identify where the pain is being generated from. It could be the disc, the spinal (facet) joints, or other soft tissues such as spinal ligaments, muscles, or even the sacroiliac joint.

Really, all you have to do is present your case exactly the way you explained it to us. The surgeon will take it from there asking you questions about your symptoms, past medical history, back injuries, and so on. Once the full picture has been drawn, it will be easier to determine the best plan of care for you based on availble evidence in the published spine literature.

As with all major surgical procedures, complications can occur. The nurse has prepared you for some of the most common complications following fusion. Other less common adverse responses can include a reaction to the anesthesia or other drugs, infection (skin or deep), and nerve damage to the voice box with anterior (from the front of the spine) cervical spine fusion.

Early recognition of these problems is essential in getting the right treatment. If you notice any odd or newly forming signs or symptoms, let your nurse and/or doctor know right away. Difficulty swallowing, hoarseness, increased pain (or new location of pain), fever, and red streaks on the skin might be some early signs and symptoms to be aware of.

If you are having a bone graft and the bone is being taken from the top of your pelvis, there can be some problems at the donor site with soreness, infection, or weakness. Sometimes the bones do not fuse as planned. This is called a nonunion or pseudarthrosis. The term pseudarthrosis means false joint. Movement at the fusion site is an indication of nonunion and a failed fusion. This may require a second (revision) surgery.

Not all patients get complete pain relief with spinal fusion. As with any surgery, you should expect some pain afterward. If the pain continues or becomes unbearable, talk to your surgeon. There may be a simple treatment that can help control your pain early on and keep it from becoming a chronic problem.

Minimally invasive spine surgery means the surgeon makes a very small incision and there is as little disruption of the underlying soft tissues as possible. They can do this now because special surgical instruments have been developed just for MISS. Intraoperative microscopes, fluoroscopes (real-time X-rays), and tube-based instruments make it all possible.

The original MISS operations started with needle-like instruments such as the endoscope used for vertebroplasty, kyphoplasty, discectomy, or destroying tumors with radiofrequency. Larger portals openings into the body with the same small incision are now possible with tube-shaped surgical tools.

The tube allows the surgeon to access a larger area underneath the incision, take photos inside the body at the operative site, and even allow for more extensive surgeries that would have needed an open incision before tubular retractors were developed. Retractors help hold the skin and underlying soft tissues open to give the surgeon access to the intended surgical area.

Like many other things in our world, improved technology is what has really made the difference. Moving from open procedures with large incisions to these smaller, minimally invasive methods will continue to change and progress. The future of robotics, distant surgeries, and more highly developed microscopic instruments with real-time computer-assisted operations is already here.

A spinal cord stimulator, also called a dorsal column stimulator, is an implanted electronic device used to help treat chronic pain. They have been used for over 30 years. The device delivers a low level electrical current through wires. The wires are placed in the area near your spinal cord. The device is similar in size to a pacemaker.

The spinal cord stimulator will not cure your pain. A 50 percent or greater decrease in pain can be expected, however. This should allow you to be more active. Also, need for less pain medication is considered a successful result. A trial with an external device for about a week is done, before having the device implanted.

Some devices are battery powered others have a radiofrequency receiver. The receiver is powered by an externally worn power source. The devices can be programmed to adjust the type and strength of the electric stimulation. The spinal cord stimulator is not necessarily permanent. It may be removed if necessary.

Until recently, the battery-powered device only lasted two to five years. It couldn’t be recharged. The device was removed surgically and replaced with another. In the last three to four years, rechargeable systems have been developed. Some companies manufacturing these devices are already promising a battery life of 10 to 25 years.

With fewer replacement costs, the overall costs of this treatment will be reduced in the coming years. instead of replacing batteries every five years (five times over a period of 25 years), replacement will take place two or three times (maybe even only once) in the same time frame. That will be a tremendous benefit to this system.

Back pain is much more episodic than cancer with a much higher risk of recurrence. In other words, many adults suffer from back pain many times over the course of a lifetime. With cancer, the hope is that anyone diagnosed with cancer will only have it once. Following cancer treatment, the goal is cure, meaning no return or recurrence of the disease.

Whether or not someone with multiple episodes of back pain or ongoing, chronic back pain can be cured is really a point up for debate. Some experts offer the opinion that it’s possible to go into remission. Remission is the absence of disease activity (or back pain) in patients with a chronic problem, but there’s a possibility that the problem could recur.

That’s strictly from a definition point-of-view. There’s much more to it than just back pain. Sometimes patients stop having pain but their activities and function are limited. This may be because they are afraid to move normally in case that movement causes a painful flare-up. Or they may not be able to complete all of their work tasks, so their productivity is down.

In either case, the condition may seem like it’s cured (or in remission) because there’s no pain but any activity limitation suggests otherwise.

Bone morphogenetic proteins (BMPs) are a group of growth factors and proteins known for their ability to start the formation of bone and cartilage. Demineralized bone with BMPs are commonly used to augment available bone graft in spinal fusion procedures.

Surgeons can choose from several commercially available human demineralized bone matrix product formulations. But studies show there can be quite a range of variability in these commercially available bone matrices products.

They don’t all have the same ability to stimulate the formation of new bone cells. Differences in constancy and potency have been shown from one product to another. In fact, different batches of the same formulation can have significant differences.

That would suggest that patients could respond differently depending on what batch of bone graft substitute they received. But there’s another variable to consider here and that’s the immune system response to an exogenous (laboratory-produced and externally delivered) graft material. The formation of antibodies to what the body considers a foreign invader could cause the body to reject the bone graft. Or at least create an allergic reaction to it.

But this hasn’t really happened that we can see. Scientists think that’s because these therapeutic proteins aren’t ingested orally or injected intravenously. They are implanted locally — right at the area of bone in the spine where the fusion must take place. By the time the body has mounted a defense, new bone has grown in the fusion site and the spine is well on its way to recovery and healing.

There may be a local inflammatory response but no systemic toxic effects have been reported. Animal studies show that by the time the immune system responds to the presence of bone morphogenetic proteins, the body has used them and already cleared them from the system. No clinically detectable allergic reactions or adverse effects have been reported. It’s not clear yet if repeated exposure to these therapeutic proteins might not have some long-term effects.

All indications are that the more time people are off from work before spinal fusion, the worse their outcomes after surgery. Patients are being encouraged to remain as active as possible up to the point of surgery including staying at work.

These recommendations come from a series of studies confirming the link between preoperative work status and outcomes after either spinal fusion or disc replacement for disc degeneration. Improvement in pain and function are greater in fusion or disc replacement patients who are off work the shortest amount of time.

The longer patients are off work before surgery, the worse their function is and the smaller their improvement. In one study from the Texas Back Institute Research Foundation, the cutoff period of time was 13 weeks. Patients who were off work for less than 13 weeks had better results compared with those who were off work longer. Patients off work for more than 13 weeks still showed improvement, just not as much as the group with the shorter off-work duration.

As a result, surgeons at that facility are telling patients who are candidates for spinal fusion to stay on the job as long as possible. It could help improve your results after surgery. They are also looking at other options. For example, maybe there’s a different way to approach postoperative rehab that could lead to better results for patients who have been off work for too long.

It’s been suggested that a few extra weeks of rehab may be needed after surgery to improve results in patients who have been inactive for so long. A similar study assessing the optimal number of weeks in rehab might help in planning the most appropriate postoperative rehab. Talk with your surgeon about this decision. Knowing your health history and general condition, he or she may have some additional thoughts or factors to consider in making this decision.

Human error can be a factor in any medical diagnosis — even for highly trained experts and involving something as black and white as an MRI. Studies show that there may be a two per cent error rate in MRIs of the spine. The most common mistake is to label something as being on the right side when it was on the left.

With MRIs of the lumbar spine, it’s also possible to mislabel the level of the involved segment. Many times this is because there is an extra or transitional vertebra making it difficult to count the sements.

Efforts are being made to guide physicians in labeling MRIs of the spine consistently no matter who reads them. Orthopedic surgeons and other spine specialists have agreed that describing disc problems should be standardized. Several groups have proposed terms to describe disc pathology such as bulging, protrusion, extrusion, and sequestration.

The American Society of Spine Radiology, American Society of Neuroradiology, and the Combined Task Force of the North American Spine Society are included in the groups advocating the standardization of terms. Recent studies indicate that many times radiologist don’t describe the morphology at all. In cases where both the attending physician and the radiologist read the MRIs and described the abnormal disc, the clinician (attending physician) was more likely to give it a higher grade indicating a more severe progression of disease than the radiologist would give it.

For example, the examining physician would label the morphology as a disc extrusion when the radiologist would call it a protrusion. In cases where the radiologist didn’t see a herniation, the morphology was labeled as a bulge. The attending physician would interpret that as a herniation.

The reason for this difference in categorization may be because the clinicians are influenced by knowing the patient’s symptoms. It’s also possible that differences in training account for differences in the way clinicians interpret lumbar MRIs.

Labeling the side of involvement incorrectly (e.g., saying it was on the right when it was really on the left) can affect treatment and result in a less successful response than hoped for — sometimes even sending the patient to surgery when conservative care failed to resolve symptoms. Operating on the wrong side is also possible with misinterpreted MRIs.

Anyone reading MRIs (even experienced radiologists) can make this mistake. You are fortunate that your surgeon has a good standard practice to guard against this by reviewing the records for each individual patient.

Safety experts suggest that a broken nose is a small injury compared to the spinal fractures that can occur without the air bags. And since motor vehicle crashes are the most common cause of spinal injury in the United States, disabling air bags is not advised.

It is true that air bags have been linked with serious injuries in infants, young children, and small adults. That’s why babies and small children should not be allowed to sit in the front seat of any vehicle with an air bag installed.

In 1997 the federal government required new passenger vehicles to come equipped with passenger-side air bags. As a result of injuries and even some deaths, the government allowed vehicle owners to disconnect their air bags. A special waiver from the National Highway Traffic Safety Administration (NHTSA) was needed in order to take this step.

However even with the waiver, finding an automotive repair shop willing to do the work may be difficult for liability reasons.

Studies show that spine fractures are more likely to occur when only wearing a seatbelt. In a recent crash study from Wisconsin, drivers and front seat passengers (ages 16 and older) who wore a seatbelt and had air bags that deployed had fewer spine fractures. The number of spine fractures was equal among patients who used only an air bag or who used no safety measures (no seat belt and no air bag).

Statistical analysis of the data showed that seat belt use alone increased the risk of spine fracture. The combined use of a seat belt and an air bag reduced the risk of cervical and thoracic spinal fractures. Relying on an air bag (without using a seat belt) increases the risk of a severe thoracic fracture.

All things considered, drivers and passengers are encouraged to keep air bags and wear their seat belts. The risk of a spine fracture (and especially a severe one at that) is less with both safety measures in place. The use of seat belt alone or air bag alone is not advised.

An accurate patient history after motor vehicle accidents is important when planning the best and most appropriate treatment. Anyone with a prior history of neck or back pain may need a different approach. Social research confirms that anyone with a psychologic profile, history of alcohol or other drug use, or mental illness will likely need special attention.

But getting at that information can be tougher than it looks. Despite taking a thorough patient history, patients don’t always reveal important facts from their past. Why do patients give inaccurate histories? In the case of psychologic issues, the patients may have the feeling that it will be a strike against them. Everyone will think they are faking, exaggerating, or malingering because they have a mental health history.

We don’t really know why this happens. But we know it happens a lot. But what they actually found was that patients frequently (about half the time) underreport previous bouts of neck and back pain. And they deny ever having treatment for these problems even when the medical records clearly showed they did have treatment at some time in the past.

Not only that, but the patients who were not at fault (the accident was caused by someone else) were much more likely to fail to report previous back and neck pain problems. Patients with a history of psychologic problems were seven times more likely to underreport information on those problems. These patients didn’t just leave out a small portion of their history. Often, they left out the entire history.

Studies have shown that underreporting occurs more often in cases where the patient was not at fault and who hired a lawyer. It’s easy to assume the patient is out for secondary gain (i.e., get all they can from this one accident). But there may be other explanations for this behavior. For example, maybe the people who underreported past history just couldn’t think straight and couldn’t remember past injuries. Maybe they didn’t have the emotional or psychologic strength to deal with all the questions, the finances, and all the paperwork.

We don’t yet know all the reasons for this type of behavior. Researchers have just confirmed that the underreporting occurs when self-reported tools are used to gather the information. There may be other (more accurate) ways to collect the data. More research is needed in this area.

The spine is divided into several sections: the neck and uppermost part is the cervical spine, the mid-back is the thoracic spine, the lower back is the lumbar spine, and the bottom part is the sacral area.

The two most fragile parts of the back are the cervical spine and the lumbar spine. The neck is subject to a lot of twisting, turning, and is easily injured when you stop suddenly and jerk your head forward and back quickly, as with whiplash. The lumbar spine can be easily injured because of its heavy load. It not only bears the load of your upper body, it bears the weight of anything you are holding and how you hold it can add to the weight and strain of the spine. At the same time, the lumbar spine has the stress of twisting and turning, plus the weight of your body and what you may be carrying.

The sacral area is most often hurt because of an injury – a fall down the stairs or on ice, for example. The thoracic spine is the one with the least number of injuries because of its location. It has the strongest base of the spine. However, this isn’t to say that injuries don’t occur. Many people have pulled muscles in their midback and the spine can become injured through trauma, disease, or something congenital, that you’re born with.

Humans are born with more vertebrae than they end up with later in life. Infants have 33, but some fuse together throughout childhood, leaving adults with 24. Some adults do have an extra vertebrae for a total of 25. The back is divided into the cervical spine (seven vertebrae), thoracic spine (12 vertebrae), lumbar spine (five vertebrae).

Ankylosing spondylitis (AS) is a chronic, painful, inflammatory arthritis that mainly affects the spine and sacroiliac joints (SIJs). It eventually causes the sacroiliac joints and spine to fuse.

X-rays show changes in the bones and joints but not until the disease has progresses. It can be up to 10 years after the start of the disease that changes are seen on the X-ray. By that time, it may be too late to change the pattern.

On the other hand, MRIs offer early clues to subtle changes in the spine and sacroiliac joints. For example, active inflammation of the sacroiliac joint called sacroiliitis is apparent with an MRI scan. Signs of sclerosis (hardening of the bone around the joint) will tip the physician off to progressive changes occurring in the sacroiliac joints and spine.

Early diagnosis and prompt treatment are essential to minimizing the damage that can occur with this condition. Controlling signs and symptoms for as long as possible is the key to maintaining spinal mobility, physical movement, and function. Type of treatment (medications, physical therapy) and aggressiveness of therapy can be aided by the information provided by all diagnostic tests (lab values, X-rays, MRIs).

Talk with the physician who made the diagnosis. There is a familial risk for ankylosing spondylitis meaning it does have a hereditary component and seems to occur within families. Studies show there are both genetic and environmental factors. About 65 per cent of the cases have a genetic basis. The physician can assess the risk of AS and related diseases in the family and make recommendations.

Sometimes this involves testing family members for the presence of the HLA-B27 gene. This test is helpful but not conclusive. Some people who have AS don’t have this gene. But, in general, people who have the HLA-B27 gene have a higher risk of developing AS than those who don’t have this gene. New research also shows there may be other genes involved (e.g., interleukin 23 receptor gene, ARTS1 gene).

The presence of back pain in someone with the gene is a yellow (warning) flag. Family members will be questioned closely about their history of signs and symptoms suggestive of AS. An MRI scan of the sacroiliac joints and spine may be needed. The MRI can show early changes that don’t appear on X-rays.

Men are 10 times more likely to be affected compared to women. When AS affects women (mother, sisters, children) of the patient with AS, they are more likely to have changes in the thoracic spine and costovertebral joints (where the ribs attach to the vertebrae).