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May 20, 2013
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Ankylosing Spondylitis, Neurologic Perspective (cont.)

Medical Author:
William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:
Melissa Conrad Stöppler, MD, Chief Medical Editor
Melissa Conrad Stöppler, MD, Chief Medical Editor
Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Ankylosing Spondylitis Diagnosis

  • The HLA-B27 antigen is found in 90%-95% of Caucasian people in the U.S. with ankylosing spondylitis. The gene is less frequent in non-Caucasian groups. However, its presence is not sufficient to make the diagnosis. The test for HLA-B27 is most helpful when the diagnosis is not clear.
  • Cerebrospinal fluid protein level may be mildly elevated during acute exacerbations of AS.
  • Low-grade anemia (decreased hemoglobin level) may be present.
  • Plain X-ray films of the pelvis may show sacroiliitis or, later, fusion of sacroiliac joints.
  • Spinal X-ray films of the lumbar region may show changes in the ligaments and fusion of facet joints (bony prominences on the vertebrae that form joints with similar projections on the upper or lower aspect of adjacent vertebrae). Extensive fusion leads to the spinal appearance of a "bamboo spine."
  • Spinal CT scan may show bony fusions and eroded laminae and spinous processes (parts of the vertebrae).
  • Flexion and extension X-ray views of the neck may be needed to document dislocation of the first two cervical vertebrae. MRI may be indicated after trauma to evaluate the spinal cord and to rule out cauda equina syndrome or epidural hematoma (blood in the space between the wall of the spinal canal and the covering of the spinal cord).
    • Cauda equina syndrome may be due to either inflammation or compression. This may occur late in the disease course.
    • In inflammatory cauda equina syndrome, the spinal canal is normal to large with cerebrospinal fluid diverticulae (outpouchings) that are best seen on MRI.
  • Plain spinal X-ray films or spinal CT scans may be indicated after trauma to evaluate for bony injury.

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