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Back Pain | Mechanical Disorders | Inflammatory & Infectious Disorders | Tumours | Trauma | Osteoporosis
Infectious and Inflammatory Causes of Back Pain:  Discitis and Ankylosing Spondylitis (AS)

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Discitis: Disc Space Infection

Discitis, or disc space infection, is an inflammatory lesion of the intervertebral disc that occurs in adults but more commonly in children. Its cause has been the subject of debate, although most authors believe it to be infectious. The infection probably begins in one of the contiguous end plates, and the disc is infected secondarily. Severe back pain that begins insidiously is characteristic of the disease.

Although most children will continue to walk in spite of the pain, young children may refuse to ambulate. The characteristic finding is extension of the spine and the child's complete refusal to flex the spine. Children with discitis usually are not systemically ill. They rarely have an elevated temperature and their white blood cell count is frequently normal. However the erythrocyte sedimentation rate is usually increased. Lateral radiographs of the spine usually will reveal disc space narrowing with erosion of the vertebral end plates of the contiguous vertebrae. Bone scanning may be helpful in localizing a lesion that is difficult to diagnose clinically. Some bone scans are falsely negative, so the diagnosis of disc space infection should not be excluded simply because the bone scan is normal. Magnetic resonance imaging (MRI) seems to be helpful in identifying a disc space infection.

The appropriate treatment of these lesions has been the subject of controversy. Most authors recommend plaster cast immobilization, a treatment that seems to be effective by itself in many cases. Some authors think that antibiotics also should be given because the condition most likely is an infection of the disc (the organism involved is frequently Staphylococcus aureus). In treating the lesion in children, a biopsy is not usually necessary. A biopsy may be indicated in adolescents or adults, especially if drug abuse is suspected, because of the possibility of organisms other than Staphylococcus aureus being present.

Courtesy of: http://www.spineuniverse.com 

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Ankylosing Spondylitis

What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) is a condition that mainly affects the spine. The joints of the neck, back and pelvis become inflamed, causing pain and stiffness. The sacroiliac joints are commonly affected in AS. These joints connect the base of your spine (sacrum) to your pelvis. Other joints, such as the hips and shoulders, can also be involved. AS can also affect other parts of the body, such as the eyes, skin, bowel and lungs. The symptoms of AS usually begin between the ages of 15 and 45 years.

What are the symptoms?

The symptoms of AS vary from person to person. The most common are:

  • pain and stiffness in the back, buttocks or neck
  • symptoms worse after rest (for example, in the early morning) and relieved with exercise
  • pain in tendons (which connect muscles to bones) and ligaments (which connect bones to each other), often felt as pain at the front of the chest, back of the heel or underneath the foot.
What causes it?

It is not known what causes AS. There is a gene called HLA–B27 that is associated with AS. Almost nine out of ten people with AS test positive for this gene. However this is a perfectly normal gene and only one in twenty people who have this gene will develop AS. You are more likely to get AS if you have a history of it in your family.

How is it diagnosed?

Many people in the early stages of AS think they have common back pain and do not seek help. However it is important to have AS diagnosed as early as possible as there are many effective treatments available. Your doctor will diagnose AS from your symptoms, a physical examination and blood tests to measure levels of inflammation. Your doctor may also order x-rays of your spine, but these tests can all be normal in the early stages. If your doctor suspects you have AS you should be referred to a rheumatologist, a doctor who specializes in arthritis.

What will happen to me?

With the right treatment, most people with AS can lead full and active lives. Many people find there are times when their symptoms worsen (known as a 'flare'), and times when their symptoms get better. In most cases AS can be well controlled with treatment and the pain improves over time. However some people may have severe, long lasting pain. As a result of the inflammation in the spine, new bone may grow around the joints. This leads to permanent stiffness in the back or neck of some people with AS. In severe cases this extra bone can fuse the bones in the spine together, stopping the spine from moving. Fusion of the spine can lead to a bent or forward stooped posture. This used to be common but can now usually be prevented by starting proper treatment as early as possible.

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Can AS be cured?

Currently there is no cure for AS. However treatment for AS has improved dramatically, with new medicines that are extremely helpful in controlling the condition. Be wary of any products or therapies that claim to cure AS.

 

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What treatments are there for AS?

Your rheumatologist will tailor your treatment to your symptoms and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. Each treatment has its own benefits and risks. Your doctor may need to trial several different treatments before finding the one that is right for you.
Treatment for AS usually involves:

  • physiotherapy exercises (such as hydrotherapy or exercises in water), to keep the spine flexible and improve posture
  • medicines, such as:
    • analgesics (pain relievers, such as paracetamol)
    • non-steroidal anti-inflammatory drugs (NSAIDs)
    • corticosteroid medicines or injections
    • disease-modifying anti-rheumatic drugs (DMARDs)
    • biological DMARDs, such as tumour necrosis factor (TNF) medicines.
  • Surgery may be required if a fracture occurs or instability of the diseased bone/spinal column occurs

For more information about medicines see the Australian Rheumatology Association's Patient Medicine Information or the Medicines and arthritis information sheet.

Australian Rheumatology Association - information about medicines and seeing a rheumatologist www.rheumatology.org.au

Courtesy of: www.arthritisvic.org.au

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