Do you know the symptoms of ankylosing spondylitis?

What is Ankylosing Spondylitis and How is it Treated?

Ankylosing spondylitis (AS), also known as Bechterew’s disease, is a type of arthritis primarily affecting the spine.  AS causes inflammation of the vertebrae, which leads to pain that often becomes chronic.  Learn more about this form of arthritis and how you can find relief.

What Does Ankylosing Spondylitis Do to the Body?

In severe cases, chronic inflammation leads bones to fuse along the spine.  This process, called ankylosis, leads to stiffening and immobility that may trigger inflammation and discomfort in the hips, shoulders, ribs, hands, and feet.  The hips are the most commonly affected area besides the spine.  There are also rare instances of AS affecting the eyes, lungs, and heart.

The pain of AS may be more or less severe in certain situations.  Because AS is an autoimmune disease, patients may experience flare-ups when the pain and stiffness intensify.

Symptoms of Ankylosing Spondylitis

Multiple symptoms could indicate you have ankylosing spondylitis.  If you have the symptoms listed below, consider seeing a doctor for a diagnosis and discussion of treatment options.

  • Lower back pain that is more severe in the morning or after you’ve been inactive
  • Difficulty walking
  • Reduced range of motion in the spine, including bending
  • Hunched posture
  • Chronic pain in affected joints, especially the hips
  • Chronic fatigue
  • Shortness of breath
  • Eye inflammation and pain

What Causes Ankylosing Spondylitis?

It’s not yet known what causes ankylosing spondylitis, but there are certain factors that put you more at risk.  For example, men are more likely to develop AS than women, and it usually develops in early adulthood or the teen years rather than later in life.

Individuals who have a specific gene called HLA-B27 are at a much higher risk for developing AS than those who don’t.  However, having this gene does not guarantee that a person will get AS.

Diagnosing Ankylosing Spondylitis

The primary feature of ankylosing spondylitis is inflammation of the sacroiliac joints at the base of the spine.  Diagnosis is done primarily through observation: physicians will first look for classic indications of this form of arthritis, including reduced range of motion, inflammation along the spine, inability to fully inflate the chest when breathing, and pain that is worse in the morning.

If AS is suspected, x-rays and blood tests will be ordered to confirm the diagnosis.  X-rays will reveal inflammation or any abnormal bone growth.  Blood tests may check for C-reactive proteins, anemia, or a lack of antinuclear antibodies, all of which may indicate AS.

Treating Ankylosing Spondylitis

Ankylosing spondylitis is a lifelong disease for which there is no cure.  However, there are several treatment options that can minimize inflammation and pain.

Medication

During the initial stages of ankylosing spondylitis, patients can take over-the-counter or prescription NSAIDs (non-steroidal anti-inflammatory drugs) to reduce swelling and minimize pain.  To augment NSAIDs, DMARDs (disease-modifying antirheumatic drugs) may also be prescribed.  These reduce the damage to joints and surrounding tissue caused by chronic inflammation.

In more severe cases of AS, corticosteroids are prescribed (usually when NSAIDs are no longer sufficient).  Steroids can be administered as shots into painful, inflamed joints to reduce swelling and give temporary pain relief.  For individuals with AS in the eyes, eye drops with steroids may be prescribed.  Short-term corticosteroid pills may also be prescribed for individuals who have a flare-up.  Unfortunately, steroids are not a long-term solution because they can cause damage to bones and tissues over time.

Two other medication options are muscle relaxants and opioids.  Muscle relaxants help with muscle spasms and stiffness triggered by joint inflammation.  Opioids are prescribed when pain is severe and hasn’t responded to NSAIDs or other medications.  Because opioids are highly addictive, they are only prescribed for short-term use and as a last resort.  Monitoring by a doctor is crucial for individuals taking opioids.

Exercise

Your doctor may recommend gentle exercises you can do at home to strengthen your muscles and improve mobility.  There are several kinds of activities that hey or she may suggest, including yoga, deep breathing techniques, and swimming.

Your doctor may also prescribe physical therapy.  Working with a physical therapist or a trainer can reduce your risk of injury.  These professionals can also guide you to learn proper exercise techniques and use heat, massage, stretching, and other treatments to reduce pain.

Topical Treatments

Heat can be applied to painful areas to soothe muscle tension and loosen stiff joints before exercising.  Ice packs may be helpful to reduce inflammation.  Talk to your doctor about which option is most effective for your situation.

If these less invasive treatments become ineffective in treating AS, surgery may be needed.

Ankylosing Spondylitis Surgery

While medication and physical therapy are preferred to treat mild to moderate ankylosing spondylitis, there are times when surgery is indicated.  If the pain is too severe for drugs, deforming of the joints has progressed, and quality of life has been impacted, surgical treatment may be necessary.

There are several kinds of surgery performed on individuals with AS, depending on which joints are affected.

Joint Replacement

Individuals with ankylosing spondylitis often sustain joint and tissue damage in areas other than the spine, particularly the hips.  Hip replacement is sometimes recommended for patients who have severe mobility issues due to hip problems.

Repair or replacement of shoulder and knee joints are also options for advanced AS patients.  Joint replacement is a complex but largely safe procedure in which damaged cartilage and bone are replaced with an artificial joint made of metal or plastic.

Spine Osteotomy

In some individuals with ankylosing spondylitis, the vertebrae in the neck become fused, causing a stooped posture.  The person may not be able to look upwards or stand up straight.  Osteotomy surgery cuts through and reshapes the bony overgrowth of the cervical vertebrae.

Spinal Instrumentation & Fusion

If the spinal column has become unstable or if ankylosing spondylitis has caused deformity of the vertebrae, spinal instrumentation and fusion may be needed.  In this procedure, the surgeon corrects any deformities and straightens the spine.  Instruments such as screws, rods, and wires are used to stabilize the area until new bone growth once again fuses the area in proper alignment.  While this procedure does limit movement somewhat, the spine will be straighter and more stable and the pain should be diminished dramatically.

Laminectomy

Ankylosing spondylitis can cause pressure on the nerves and spinal cord.  This often leads to loss of coordination, weakness, and a tingling feeling in the extremities.  A laminectomy is a type of decompression surgery that removes pressure on the spinal cord and nerves.

During the procedure, rods, bone grafts, and screws are used to stabilize the area.  A section of any damaged vertebrae is removed.  This section, called the lamina, is the flattened area of the bone’s arch that helps protect the spinal cord.  Once it has been removed, pressure on the spinal cord and nerves is relieved.  Surgeons may also carefully move some muscles aside to they will not continue to put pressure on the spine.  Laminectomy is a minimally invasive procedure done through a small incision and takes only a few hours.

Experts in Ankylosing Spondylitis Treatment Options

Our spine surgeons treat many patients with ankylosing spondylitis every year.  If you suspect you have AS, contact Arkansas Surgical Hospital at (877) 918-7020 to schedule an appointment.  We will offer various treatment options and help you determine what kind of treatment or surgery is best to help alleviate your AS symptoms.

Proper marathon training can prevent injury.

Preparing for the Little Rock Marathon

In the weeks leading up to the 2020 Little Rock Marathon, it’s more important than ever to practice a safe and effective exercise routine, get plenty of rest, and maintain a diet that will fuel your body without weighing it down.  With proper preparation, you’ll be able to minimize the chance of injury and use your training to your full potential on March 1st.

Read on for an overview of the marathon training process with advice from blogger Tia Stone, a 3-time winner of the Little Rock Marathon.

Read More

Minimally Invasive Surgery for Spinal Stenosis

Spinal stenosis can occur as a result of arthritis, injury, or as part of the aging process.  Learn more about spinal stenosis, including its causes and symptoms, and the types of minimally invasive surgeries that can treat it.

What is Spinal Stenosis?

When the spinal canal narrows, pressure is put on the spinal cord and the nerve roots found there.  This condition is called spinal stenosis.

Spinal stenosis can be caused by the following:

  • Arthritis.  Rheumatoid arthritis and osteoarthritis of the spine result in deterioration of the cartilage that cushions your vertebrae.  This can cause your facet joints (the joints between the vertebrae) to thicken.  It can also cause osteophytes, or bone spurs, to form.
  • Disc problems.  Degenerative disease, injury, or wear and tear can lead to disc damage.  For example, when an intervertebral disc is herniated, its gel-like inner tissue bulges out of the weakened outer layer.  This reduces space in your spinal canal and can cause nerve compression.
  • Thickened ligaments.  Your vertebrae are connected by ligaments that help keep your spine stable.  These ligaments may grow thicker in reaction to destabilization of your spine, causing compression of your spinal cord.

What Are the Symptoms of Spinal Stenosis?

The most common symptoms of spinal stenosis are pain, numbness, and weakness.  Depending on where the compression occurs in your spine, the location of these symptoms varies.  For example, lumbar (lower back) stenosis leads to symptoms in the back, buttocks, and legs, while cervical (neck) stenosis affects the shoulders, arms, and hands.  Spinal stenosis can also cause loss of coordination, difficulty walking, and reduced bowel and bladder control.

Types of Minimally Invasive Surgery for Spinal Stenosis

The general term for reducing pressure on your spinal cord and/or nerves is decompression.  A wide variety of minimally invasive decompression procedures have been developed to treat spinal stenosis.  Minimally invasive surgeries use tiny incisions and tools, resulting in less blood loss and quicker healing times.

Discectomy

A discectomy involves trimming a damaged intervertebral disc to reduce pressure on your spinal cord.  If a significant portion—or all—of the disc is removed, fusion may then be performed to stabilize the spine.

Fusion

The goal of fusion is to prevent unwanted movement in your spine by causing bone to grow between the vertebrae.  Your orthopedic surgeon will fuse together two or more of your vertebrae using a bone graft or tools such as screws, wires, or rods.  Fusion can be done separately or in addition to decompression procedures that may destabilize your spine.

Laminectomy

Laminae are thin pieces of bone at the back of your vertebrae.  If a lamina has begun to thicken or develop bone spurs, removing it in a process called a laminectomy will allow more room within your spinal canal.  A laminectomy might also include trimming spinal ligaments, facet joints, and spinous processes (the bony growths you can feel along the back of your spine) to create even more room.

Foraminotomy

Foramen are the passageways at the sides of your vertebrae that protect your nerve roots as they exit the spinal cord.  Bone spurs or herniated discs can reduce the size of the foramen, causing compression of the nerve roots.  A foraminotomy makes the foramen bigger by removing tiny portions of bone or disc material that are causing the compression.

Living with Spinal Stenosis?

If you are experiencing symptoms of spinal stenosis, contact Arkansas Surgical Hospital for help making an appointment with one of our specialists.

Stress fractures are common in the feet and legs.

Stress Fracture Types & Treatments

Stress fractures are common injuries experienced by people of all ages and activity levels.  Learn more about the different types of stress fractures and the treatment options available at Arkansas Surgical Hospital.

Low-Risk Stress Fractures

Low-risk stress fractures can usually heal without requiring surgery.  They are not likely to develop complications.  Common locations of low-risk stress fractures include your fibula, which is next to your shin bone, and your calcaneus, or heel bone.

Conservative treatment involving RICE (rest, ice, compression, and elevation), NSAIDs (non-steroidal anti-inflammatory drugs), and limited weightbearing is the standard first line of treatment.  This treatment can last anywhere from around six weeks to a full year and is typically enough to heal your stress fracture when there are no complications.  However, low-risk stress fractures can sometimes progress to high-risk stress fractures if conservative measures do not help.

High-Risk Stress Fractures

Stress fractures are categorized as high-risk if there is a high chance of displacement, delayed union, non-union, or completion (a complete break) of the fracture.  These stress fractures often occur in areas with low blood supply, which is necessary for bone development.  Examples of these areas include certain bones in your feet, such as the metatarsals (the long, tubular bones in the middle of your foot) and the navicular (a concave bone towards the inner side of your foot).

Other high-risk stress fracture locations include “tension-side” bones, which means they bear weight as your body goes through various movements.  Stress fractures in these areas are more likely to become displaced or progress to a complete fracture.  One of these locations is the outer side of your femur, or thigh bone.

Finally, bones in areas without much muscle or other soft tissue coverage—such as your tibia, or shin bone—are also prone to high-risk stress fractures.  If your stress fracture is in one of these areas, your orthopedic surgeon may recommend surgery.  While some high-risk stress fractures heal on their own, surgical intervention is often needed to ensure complete healing.

If your stress fracture does not heal with rest, you may need surgery.  There are several different surgical techniques for stress fracture treatment, including screws, wires, rods, and plates designed to help your bone progress to full union.

Displaced Stress Fractures

Displacement is the term used to describe bone edges that have moved out of alignment, which makes it harder for your stress fracture to heal.

Displacement has several risks.  For example, displaced stress fractures in your femur can lead to avascular necrosis—the death of bone tissue caused by lack of blood supply—in the ball of your joint, which can cause arthritis or even collapse of the bone.

If your stress fracture is displaced, your treatment will need to be more aggressive.  Your bone will need to be immobilized, usually using a cast or splint, and you will need to rest it completely (i.e., no weight-bearing or unnecessary activity) for several weeks.  If that does not help, internal fixation using screws or rods is the next step to ensure healing of your stress fracture.

Delayed Union and Non-Union of Stress Fractures

There are several factors that can slow down or even prevent the healing of your stress fracture, including diabetes, hormone imbalance, and unhealthy habits.

In order to ensure complete healing of your stress fracture, you will need to follow your orthopedic surgeon’s instructions on what to do—and what not to do—before, during, and after your treatment.  Examples include:

  • Stop smoking.  Nicotine delays healing and tobacco weakens your bones.
  • Improve your diet.  Insufficient calcium and vitamin D can make it more difficult for your stress fracture to heal.
  • Do not return to activity before your orthopedic surgeon approves it.  This could delay healing and may even result in a complete fracture.

Diagnosed with a Stress Fracture?

If you are suffering from a stress fracture, contact Arkansas Surgical Hospital at (877) 918-7020 for help setting up an appointment with one of our specialists.

Arkansas Surgical Hospital Receives 2019 Press Ganey Guardian of Excellence Award®️ for Patient Experience

NORTH LITTLE ROCK – Arkansas Surgical Hospital has been named a 2019 Guardian of Excellence Award® winner by Press Ganey and is the only hospital in Arkansas to receive this recognition.

The nationally-recognized award honors top-performing health care organizations that have achieved the 95th percentile or above in Patient Experience.  Presented annually, the award names clients who consistently sustained performance in the top 5% of all Press Ganey clients for each reporting period during the course of one year.

The 2019 award recipients were honored at the Press Ganey National Client Conference in Orlando, Florida on November 18.

Arkansas Surgical Hospital receives the 2019 Press Ganey Guardian of Excellence Award.

Representatives of Arkansas Surgical Hospital at the Press Ganey National Client Conference in Orlando, Florida. Left to right: Andrew Covington, CFO; Brian Fowler, COO; Carrie Helm, CEO; Kent Hammond, Director of Patient Care Services; Sarah Loftin, Director of Quality Services.

Arkansas Surgical Hospital at the 2019 Press Ganey National Client Conference

Representatives of Arkansas Surgical Hospital accepting the Guardian of Excellence Award from Patrick T. Ryan, Executive Chairman of Press Ganey Associates.

According to Helm, the award represents an important recognition from the industry’s leader in measuring, understanding, and improving the delivery of care.

“It is an honor for our hospital to be named a Guardian of Excellence for Patient Experience,” said Helm.  “This prestigious award is further proof that our commitment to exceptional care is being recognized by those to whom it matters most: our patients.”

“Congratulations to Arkansas Surgical Hospital for receiving the Guardian of Excellence Award,” said Patrick T. Ryan, Executive Chairman of Press Ganey.  “This honor reflects their unwavering commitment to improving the safety, quality, and experience of care.  Their hard work and dedication are inspiring, and we are proud to partner with them on our shared mission to reduce patient suffering.”

About Arkansas Surgical Hospital: Arkansas Surgical Hospital, the leader in orthopedic and spine surgery in Arkansas, is located in North Little Rock.  The physician owners at Arkansas Surgical Hospital are focused on exceptional outcomes for their patients.  This includes a commitment to patient safety, care, and comfort for patients and their families.  To learn more about Arkansas Surgical Hospital, visit ArkSurgicalHospital.com.

About Press Ganey: Press Ganey pioneered the health care performance improvement movement more than 30 years ago.  Today, Press Ganey offers an integrated suite of solutions that enables enterprise transformation across the patient journey.  Delivered through a cutting-edge digital platform built on a foundation of data security, Press Ganey solutions address safety, clinical excellence, patient experience, and workforce engagement.  The company works with more than 41,000 health care facilities in its mission to reduce patient suffering and enhance caregiver resilience to improve the overall safety, quality, and experience of care.

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