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Q: The exasperation of cracked vertebra leading to/causing Ankylosing Spondylitis ( Answered,   1 Comment )
Subject: The exasperation of cracked vertebra leading to/causing Ankylosing Spondylitis
Category: Health
Asked by: ygar-ga
List Price: $20.00
Posted: 13 Aug 2006 12:28 PDT
Expires: 12 Sep 2006 12:28 PDT
Question ID: 755590
This is very important to me.  I need to know current medical data confirming
that broken or cracked vertebra, e.g. lumbar transverse processes, may or better
yet, can or will lead to the occurrence of Ankylosing Spondylitis, a form of
arthritis--with references.  Thank you very much!
Subject: Re: The exasperation of cracked vertebra leading to/causing Ankylosing Spondylit
Answered By: crabcakes-ga on 29 Aug 2006 18:20 PDT
Hello Ygar,

 After an exhaustive search, I have found no evidence that vertebral
fractures or fractures of the lumbar transverse processes contributes
to AS. On the contrary, I have found that AS itself can lead to
fractures, due to the body?s attempt to rebuild bone, causing
vertebral fusion. AS is considered a disease of genetic origin.

?AS tends to run in families. Just as we inherit our hair colour and
blood type from our parents, we also inherit our tissue type. The
tissue typing system is the Human Lymphocyte Antigen (HLA) system. One
of the tissue types, HLA-B27, is found in only 6% of the broad
population but occurs in approximately 93% of individuals with AS.

The HLA-B27 tissue type, while not causing AS, does predispose
individuals with the B27 tissue type to developing AS. Thus we see AS
tending to occur in families. Having the tissue type itself does not
mean you will get AS, it simply increases the possibility. Identifying
the activating agent that later triggers AS is the focus of much
current research. There is discussion among researchers that other
genes in the immune system may also lead to the development of AS,
perhaps by interacting with some environmental factor.?

?The most classic site of involvement is the sacroiliac (SI) joints on
the right and/or left sides in the buttock area. Unfortunately, X-ray
evidence of changes in the SI joints may take some time to occur, thus
an X-ray taken in the early years of the problem may be negative. Over
time the SI joints will usually show changes that can be seen on
X-ray. In addition to the SI joint x-ray changes, changes at the edges
of some vertebrae may be observed.?

   ?The tendency for developing ankylosing spondylitis is believed to
be genetically inherited, and the majority (nearly 90%) of patients
with ankylosing spondylitis are born with the HLA-B27 gene. Blood
tests have been developed to detect the HLA-B27 gene marker, and have
furthered our understanding of the relationship between HLA-B27 and
ankylosing spondylitis. The HLA-B27 gene appears only to increase the
tendency of developing ankylosing spondylitis, while some additional
factor(s), perhaps environmental, are necessary for the disease to
appear or become expressed.?

?Patients who have chronic, severe inflammation of the spine can
develop a complete bony fusion of the spine (ankylosis). Once fused,
the pain in the spine disappears, but the patient has a complete loss
of spine mobility. These fused spines are particularly brittle and
vulnerable to breakage (fracture) when involved in trauma, such as
motor vehicle accidents. A sudden onset of pain and mobility in the
spinal area of these patients can indicate bone fracture. The lower
neck (cervical spine) is the most common area for such fractures.?

    ?Why can patients with ankylosing spondylitis (AS) have a more
fragile skeleton? According to Dr. Walter P. Maksymowych, one possible
reason is that, "We now know that severe inflammation -- wherever it
exists -- causes the release of certain chemicals into the blood that
activate cells in bone that can literally dissolve bone mineral."

   ?CONCLUSIONS: Spinal and hip osteopenia and vertebral fractures are
a feature of mild AS. However, there was no correlation between BMD
(bone mineral density). AS patients with mild disease had a higher
risk of fractures compared with the normal population and this
increased with the duration of disease.?

   ?CONCLUSION--Vertebral compression fractures due to osteoporosis
are a common but frequently unrecognised complication of ankylosing
spondylitis and may contribute to the pathogenesis of spinal deformity
and back pain.?

   ?A.S. causes inflammation outside the joint where the ligaments and
tendons are attached to the bone, whereas in most forms of arthritis,
inflammation affects the inside of the joint. It usually affects the
little joints between the vertebrae of the spine and tends to diminish
the movement which takes place at these joints.?

What causes ankylosing spondylitis?
As with other forms of arthritis, the cause is not known, but there
appears to be a hereditary factor (gene HLA B27 occurs in 90% of
people with A.S, although having the gene doesn't necessarily mean you
will develop A.S).
?The inflammation causes more bone to be removed from the spine than
to be laid down. Therefore, the spine becomes thinner and has lower
density. If this continued there would be the risk that it could not
support the weight of the body and would develop ?crush? fractures.
However, the body lays down bone between the vertebra. This thickens
the spine and allows it to support the weight of the body (even though
some part are still thin). However, accidents like falls will still
mean that a very stiff and ridge spine can not bend and can still
fracture in the areas which are low bone density or thin.

In a study of 66 men with AS, 11 (17%) had a fracture of the vertebra.
However, this rate would be influenced by how long you have had
disease, how active you are, and your age.?

   ?Chronic back pain ? ankylosing spondylitis. May have early
appearance in childhood as episodes of arthritis. In late teens and
early 20s appears as pain and morning stiffness in the lumbar regions
and hips and slowly moves up the back. Symptoms fluctuate. Tenderness
over involved joints, spine loses flexibility, normal lumbar lordosis
is straightened, spinal rotation and lateral bending are decreased.?

??  The spinal disease starts in the sacroiliac joints (bilateral
lumbosacral region) and progresses proximally, with ossification of
the annulus fibrosus that results in fusion of the spine (bamboo
spine). On examination there is often tenderness of the sacroiliac
joints or a limited range of spine motion. May have loss of lumbar
lordosis and accentuated thoracic kyphosis. Stiffness and kyphosis
resulting in a stooped posture are characteristic in the advanced

?  Peripheral enthesitis: occurs in approximately 33% of patients and
often involves the Achilles tendon insertion, the insertion of the
plantar fascia on the calcaneus or the metatarsal heads, the base of
the fifth metatarsal head, the tibial tuberosity, the superior and
inferior poles of the patella and the iliac crest. Lesions tend to be
painful, especially in the morning. There may be associated swelling
of the tendon or ligament insertion.

?  Peripheral arthritis: occurs in 33% of patients. Joint involvement
tends to occur most often in the hips (often bilateral), shoulder
girdle (glenohumeral, acromioclavicular, sternoclavicular joints), and
joints of the chest wall (costovertebral joints, costosternal
junctions) and symphysis pubis. other peripheral joints are less often
and less severely affected, usually as asymmetrical oligoarthritis.
Temporomandibular joints are occasionally involved.?
?Neurological involvement: frequently occur secondary to fractures of
a fused spine. Also are prone to atlantoaxial subluxation, which may
lead to cervical myelopathy. Cauda equina syndrome may occur in
patients with severe long-standing disease.?
?Metabolic bone disease: osteopenia and osteoporosis may occur in
patients with long-standing spondylitis, resulting in an increased
risk of fracture.?

   ?Metabolic bone disease: osteopenia and osteoporosis may occur in
patients with long-standing spondylitis, resulting in an increased
risk of fracture.?

   ?Most vertebrae exhibit pronounced lateral protrusions (or
processes), one on each side of the vertebra. These transverse
processes serve as the attachment sites for ligaments (intertransverse
ligaments) and muscles, which control the bending and twisting of the
vertebral column. The base of each transverse process in most
vertebrae is just off of the main body of the vertebra, located
instead at the pedicle. The pedicle is part of the ring-like structure
of a vertebra, which also includes the body and lamina of a vertebra,
forming the vertebral foramen which protects the spinal cord.?

   ?Vertebral fractures of the thoracic and lumbar spine are usually
associated with major trauma and can cause spinal cord damage that
results in neural deficits. Each vertebral region has unique
anatomical and functional features that result in specific injuries.?

   ?We conclude that symptomatic VF in men are associated with reduced
BMD, underlying causes of secondary osteoporosis such as
corticosteroid and anti-convulsant treatment, family history of bone
disease, current smoking and high alcohol consumption, and that they
impair the perceived health of the individual.?

   I hope this has helped! Please request an Answer Clarification, if
anything is unclear, and allow me to respond.

Sincerely, Crabcakes

Search Terms
Prevalence of Vertebral Fractures in ankylosing spondylitis
vertebral fractures + AS
Cause of  vertebral fractures
vertebral fractures + sequelae
ankylosing spondylitis + vertebral fractures
Subject: Re: The exasperation of cracked vertebra leading to/causing Ankylosing Spondylitis
From: pinkfreud-ga on 13 Aug 2006 12:48 PDT
"Ankylosing spondylitis is not caused by infection or injury.  It is
not known exactly why the inflammation occurs, but there is a genetic
susceptibility to the disease.  This is indicated by the presence of
the HLA-B27 antigen in the blood and tissues.  About 20% of the
population have this antigen, but it is present in 95% of people with
ankylosing spondylitis.  People with HLA-B27 antigen have a greater
than normal chance of developing any of a group of related
inflammatory diseases including ulcerative colitis, Crohn?s Diseas,
Reiter?s Disease and psoriasis."

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