Ankylosing Spondylitis
Last modified: 17 June 2022, 4:02:28 PM AEST
Origin / Etymology1 / 10
- Ankylosing / Anklylosis
- Fused bones
- Ankylos = Greek = bent / crooked / curved
- Spondylitis
- Inflammation of vertebrae
- Spondylosis
- Any of various degenerative diseases of spine
- Spondylos = Vertebrae
Definition / diagnostic criteria2 / 10
- seronegative spondyloarthropathy
- axial spondyloarthritis
- multisystem inflammatory disease with extra-articular features
- 0.1-0.8% prevalence
- onset young adulthood
- unknown cause
- likely autoimmune mechanism
- 85% patients have HLA-B27 antigen
- HLA = Human Leucocyte Antigen
Complications / Issues3 / 10
- A = Airway
- TMJ dysfunction
- A = C-spine
- occult cervical fracture (with minimal trauma)
- atlanto-axial subluxation
- cervical fusion
- B = Respiratory
- Pulmonary fibrosis = parenchymal fibrosis = restrictive lung disease
- Chest wall MSk disease
- C = Cardiovascular
- Aortic regurgitation
- myocarditis
- conduction defects
- Cardiomegaly
- Cardiomyopathy
- Pericardial effusion
- D = Neurological
- Spondylolisthesis = causing cord compression
- D = Ophthalmology
- uveitis / iritis
- common and maybe severe
- uveitis / iritis
- E = Endocrine
- F = Renal
- Amyloid deposits
- G = Gastrointestinal
- H = Haematological
- I = Immune
- J = MSk
- tendoachilles
- costochondritis
Symptoms / History4 / 10
- Back pain
- radiating to sacro-iliac joints and hips
- worse at night
- improves after movement
Signs / Examination5 / 10
-
General inspection
- stiff posture
- kyphosis maybe present
-
Spinal tenderness
-
Sacroiliac joint tenderness
-
Hips = reduced ROM
Investigations6 / 10
- RFTs
- Echo
- C-spine XR
- Spine XR
- bamboo spine = pathognomonic radiographic feature
- ossification of outer fibres of annulus fibrosus of intervertebral discs
- formation of marginal syndesmophytes
- bamboo spine = pathognomonic radiographic feature
- FBC
- normochromic anaemia = AOCD
Management7 / 10
- NSAIDs
- Steroids
- Immunomodulators
- bone marrow suppression
- Platelet dysfunction
- Renal impairment
- need for steroid coverage
Anaesthetic considerations8 / 10
- Pre-op
- consider multisystem disease features, esp cardiopulmonary
- Intra-op
- A = Minimise C-spine manipulation
- consider AFOI
- D = NA may be difficult / impossible
- poor positioning
- epidural space obliteration
- ⬆risk epidural haematoma (ASRA)
- paramedian approach + ultrasound ***
- careful patient positioning = peripheral N injury
- A = Minimise C-spine manipulation
- Post-op
Common questions / related topics9 / 10
Ank Spond + Pregnancy
- Complicated due to difficult AW and NA
- Have multiple plans in place
Ank Spond = Technique of intubation
- Awake FOB
- Asleep dual technique = VL + FOB + 2 operators
Ank Spond = Awake FOB failure
- Defer surgery
- Asleep FOB / awake trache
Ank Spond = Ruptured Achilles tendon
- What problems do you anticipate?
- Difficult positioning in prone position