What is “inflammatory spondylopathy”?
“Spondylopathy” means any ailment affecting the spine. Any ailment of the spine due to inflammation alone is termed “inflammatory spondylopathy”.
What are the different types of “inflammatory spondylopathy”?
Ankylosing spondylitis is the most common type of inflammatory spondylopathy, almost like a prototype of this group of disorders. This commonly affects the lower back. Other afflictions include psoriatic arthritis, Reiter’s arthritis, enteric spondyloarthropathy, etc. Rheumatoid arthritis also belongs to this group and it commonly afflicts the cervical spine [neck region].
What causes “inflammatory spondylopathy”?
Nature has provided our body with some defense system against infections. When this defense system goes awry, it would start attacking one’s own body. When it attacks the spinal column, it leads to inflammatory spondylopathy.
How does “inflammatory spondylopathy” manifest?
The spinal column is made up of a number of bones called “vertebrae”. These vertebrae are joined together by intervertebral discs. This arrangement has been made by nature so as to facilitate movement between these bones, allowing for the normal flexibility of the spine. Inflammatory spondylopathy leads to extra bone growth across these individual bones, converting all these individual bones into a single bone. This would lead to stiffness in the spine. In the early stages of the disease, maximum pain and stiffness is noted in the early mornings and also during cold weather. In later stages of the disease, the spine can develop deformities in addition to stiffness. In addition to the spine, these problems can also affect some other joints of the body, notably the hip joints.
How is “inflammatory spondylopathy” diagnosed?
An accurate history is the most important diagnostic tool. The way the pain started and progressed; specific aggravating and relieving factors of pain; distribution of pain over your body, associated complaints such as weakness or numbness over the lower limbs will be a guide to short listing the possible causes of your back pain.
A detailed clinical examination involving assessment of spinal motion, assessment of your neurology and certain special tests would follow then.
Though this process of history-taking and clinical examination may appear boring and long-drawn, it is the most crucial part towards prescribing the correct treatment to you. So, it is essential to cooperate with your doctor throughout this entire procedure, which gives more information to the doctor regarding your ailment than any other investigation on earth.
What are the investigations ordered to confirm the diagnosis of inflammatory spondylopathy?
Commonly, plain x-rays of the spine may be ordered with some basic blood investigations such as hemoglobin, erythrocyte sedimentation rate [ESR] and CRP. Specific blood tests would include HLA-B27, RA, ASLO, ANA, etc. Based on these tests, or sometimes, in the presence of some very significant signs or symptoms, you may be asked to undergo MRI scanning. Plain x-rays demonstrate bony features; while MRI demonstrates the spinal cord, its nerve roots, the intervertebral disc between the two bones of the spine. Both these tests are complimentary in nature; doing one does not necessarily mean that the other one is not needed. Rarely, a nuclear bone scan may be asked for.
How is inflammatory spondylopathy treated?
Most patients respond to a course of medications and exercises. Medications are used to reduce the inflammation in the body. These would generally be used for a few months. Over this period, regular blood investigations would be needed to monitor the response to treatment. In addition, specific exercises would be started to maintain the flexibility of spine. Respiratory exercises would be started to maintain the normal flexibility of chest wall, which can get significantly hampered in this disease. Regular hot water baths would be encouraged. If facilities are available, regular saunas/ jacuzzis would also be helpful. Surgical treatment for the spine is rarely required when the spine develops severe deformity leading to impairment of the overall spinal balance or impairment of normal vision or impairment in any activity of daily living. Surgical treatment is more often required for involvement of the hip joint that can get severely arthritic. It would then require a hip joint replacement surgery.
Is the spine surgery safe?
Rather than asking the question as to whether spine surgery is safe; it is more candid to ask as to what are the problems that a patient will face, if he undergoes surgery and what if he does not undergo surgery? What are the benefits a patient will have, if he undergoes surgery and what if he does not undergo surgery? Again, spine surgery is not like cosmetic surgery; i.e. it is not optional! Any learned, well-trained spine surgeon would offer spine surgery only if all other options are reasonably exhausted. This does not mean that spine surgery has no complications at all. Everything that we do in life carries some inherent risk. Even if we are driving our car on the road, we are running a risk of an accident! On a similar ground, spine surgery too has its own share of risks; but any learned, well-trained spine surgeon would offer spine surgery only if the benefits outweigh the risks by a factor of at least 10:1! Also, there have been a lot of advances in the field of spine surgery, which has rendered the knowledge contained in even 10-15 year old textbooks as obsolete! The advent of MRI for preoperative diagnostics has allowed the surgeon to rule out any problems within the spinal cord that might limit the surgical options. The advent of intraoperative imaging such as C-arm and computer-aided navigation has given a very safe option for inserting metal implants into the spine, thus improving the postoperative rehabilitation of these patients and also tremendously increasing the safety levels of these surgeries. The use of operating microscope allows for safe handling of neural tissues, minimizing neurotrauma. All this coupled with numerous scientific studies to study various factors to enhance the efficacy of spine surgery and we have a scenario, where the risks associated with spine surgery are significantly neutralized!
So, if you have a problem that genuinely requires surgery, there is no point in denying yourself the benefits of today’s medical advances! Discuss the details of your surgery and its attendant risks with your doctor to quell any fears and to clear any and every doubt of yours! If you so desire, your doctor can even arrange to give you references of patients who have undergone similar surgeries.