The Orthobullets Podcast

Foundations | Spine | Ankylosing Spondylitis

Dec 11, 2025
Dive into the intricacies of ankylosing spondylitis, where experts define and outline diagnostic criteria like HLA-B27. Discover the hallmark symptoms and diagnostic tests, including the Schober test. Learn about critical imaging characteristics that reveal syndesmophytes and the infamous bamboo spine. Explore nonoperative management techniques, including NSAIDs and the role of TNF-alpha inhibitors. Finally, delve into surgical options for spinal deformities and critical fracture management strategies.
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INSIGHT

Core Definition And Diagnostic Hallmarks

  • Ankylosing spondylitis is a chronic seronegative spondyloarthropathy with bridging osteophytes, enthesitis, sacroiliitis, and uveitis.
  • Diagnosis commonly involves HLA-B27 positivity and bilateral sacroiliitis along with ocular exam for uveitis.
INSIGHT

Enthesitis Drives The 'Bamboo Spine'

  • Enthesitis causes bony erosion then ossification leading to joint ankylosis, often at SI joints, apophysial joints, and symphysis pubis.
  • Disc annulus inflammation produces marginal syndesmophytes and progressive autofusion.
ADVICE

Practical Exam Maneuvers To Assess Function

  • Use the Schober test and measure chest expansion to evaluate lumbar stiffness and restrictive chest wall involvement.
  • Check for reduced horizontal gaze and differentiate hip contracture versus spinal kyphosis with supine and sitting exams.
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