Doctors often refer to spinal fusion as “bamboo spine.”
Early on with ankylosing spondylitis, or AS, you might think you can tolerate the symptoms. Some back pain and stiffness is certainly uncomfortable and inconvenient, but you can find ways to cope. The problem is, AS is a progressive condition. Without treatment, your AS can progress to a serious complication: spinal fusion, or ankylosis.
“Spinal fusion is when parts of the spine fuse together and become immobile,” says Anca D. Askanase, MD, MPH, rheumatologist at Columbia University Irving Medical Center. “That could involve parts of the spine, or it can involve the whole spine. Traditionally, it's described as the bamboo spine.”
Imagine a bamboo stalk. Whereas a traditional spine has several pieces (vertebrae) that allow the spine to curve and bend, a bamboo stalk is one rigid stick. When AS progresses, inflammation and damage to the spine causes the vertebrae to fuse together, becoming immobile and rigid like a bamboo stalk.
What Makes Ankylosis So Destructive
There are two major problems with spinal fusion: its effect on your quality of life, and its effect on the physical health of your body.
Spinal fusion affects quality of life by severely limiting mobility. This can be even worse if the spine fuses in an unnatural, hunched-over position. As a result, simple things like eating or getting dressed can be particularly challenging.
Furthermore, spinal fusion can compromise the health of the rest of your body. “If there's kyphosis, which is the bent-over position, the internal organs become squished a little bit,” says Dr. Askanase. “The breathing capacity is diminished, the heart function is impaired, the organs are affected, and that's the time when a surgical intervention may be in order.”
Treating Spinal Fusion
It’s easier to prevent ankylosis than it is to treat it. Unfortunately, once fusion occurs, the only option to correct it is with surgery.
“Spine surgery is not simple surgery. They are complicated, complex, long surgeries, whose outcomes are not always as perfect as we'd like them to be,” says Dr. Askanase. “They are attempts at maintaining function, [but] there's nothing better for any organ or any part of the body than keeping the one that we had started with functional.”
Getting an early diagnosis for AS and sticking to medications and lifestyle modifications should prevent spinal fusion for most people. Learn more here about medication options to treat AS.
“With our better understanding of the disease, with our better understanding of the treatment options, both lifestyle and medication options, the risk of spinal fusion is much lower than ever before,” says Dr. Askanase.
Dr. Askanase is a rheumatologist specializing in lupus, Sjogren's syndrome, and vasculitis at Columbia University Irving Medical Center. She is the founder and clinical director of Columbia's Lupus Center and the Director of Rheumatology Clinical Trials.
00:00:01.567 --> 00:00:04.532
(Dr. Askanase) Inflammation in ankylosing spondylitis
00:00:04.533 --> 00:00:06.999
happens in the sacroiliac joints,
00:00:07.000 --> 00:00:08.766
the joints in the middle of the pelvis,
00:00:08.767 --> 00:00:10.266
and in the spine,
00:00:10.267 --> 00:00:13.832
and the spine that normally is able to move,
00:00:13.833 --> 00:00:18.999
in ankylosing spondylitis, becomes straight and rigid
00:00:19.000 --> 00:00:21.999
or bent over and rigid.
00:00:22.000 --> 00:00:24.232
That's the dreaded fusion.
00:00:24.233 --> 00:00:28.599
(soft guitar music)
00:00:28.600 --> 00:00:31.599
Spinal fusion is when parts of the spine
00:00:31.600 --> 00:00:34.432
fuse together and become immobile.
00:00:34.433 --> 00:00:37.999
If there's kyphosis, which is the bent-over position,
00:00:38.000 --> 00:00:42.799
the internal organs becomes squished a little bit,
00:00:42.800 --> 00:00:45.099
and breathing capacity is diminished,
00:00:45.100 --> 00:00:49.399
the heart function is impaired,
the organs are affected,
00:00:49.400 --> 00:00:51.766
and that's the time when a surgical intervention
00:00:51.767 --> 00:00:54.332
may be in order.
So there's a normal curvature
00:00:54.333 --> 00:00:57.399
to the spine, and then with inflammation,
00:00:57.400 --> 00:01:01.366
that gets lost, and if that's lost
in a straight-up position,
00:01:01.367 --> 00:01:04.399
for those people that have excellent posture
to start with
00:01:04.400 --> 00:01:06.366
and have worked on their physical therapy,
00:01:06.367 --> 00:01:08.866
that's more physiologic than when it happens
00:01:08.867 --> 00:01:11.099
for people that have bad posture
00:01:11.100 --> 00:01:12.866
and end up more hunched over.
00:01:12.867 --> 00:01:16.366
All bouts of inflammation can lead to damage.
00:01:16.367 --> 00:01:18.666
The quicker we quench the inflammation,
00:01:18.667 --> 00:01:21.566
the less likely that damage will accumulate.
00:01:21.567 --> 00:01:24.199
To lower the risk of spinal fusion,
00:01:24.200 --> 00:01:27.432
one needs to take their medications,
00:01:27.433 --> 00:01:29.766
work with their doctor to figure out
00:01:29.767 --> 00:01:31.699
the best medication for them.
00:01:31.700 --> 00:01:34.666
Physical therapy and an exercise regimen
00:01:34.667 --> 00:01:37.499
are critical to maintaining spine mobility.
00:01:37.500 --> 00:01:40.166
Range of motion, core strengthening,
00:01:40.167 --> 00:01:45.032
mobility exercises are part of what
your physical therapist
00:01:45.033 --> 00:01:48.566
will teach you, and you can do those exercises
00:01:48.567 --> 00:01:51.132
with a therapist, but you also should be doing them
00:01:51.133 --> 00:01:53.766
on your own every day if possible.
00:01:53.767 --> 00:01:56.499
With our better understanding of the disease,
00:01:56.500 --> 00:01:59.832
with our better understanding
of the treatment options,
00:01:59.833 --> 00:02:03.166
both lifestyle and medication options,
00:02:03.167 --> 00:02:08.500
the risk of spinal fusion is much lower than ever before.
- Ankylosing spondylitis. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2020. (Accessed on September 29, 2020)
- Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020. (Accessed on September 29, 2020)