What is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the spine, though it may involve other joints such as the hips and shoulders. The term “ankylosing” means stiffening, and “spondylitis” refers to inflammation of the spinal bones. Over time, the inflammation can lead to pain, stiffness, and a loss of mobility.

Who is Affected?
AS most commonly affects:

• Gender: Males, three times more frequently than females.
• Age Group: Young adults, with a peak onset between 20 and 30 years.
• Children: A form of the condition called juvenile ankylosing spondylitis can affect those under 16 years of age.

Risk Factors:

1. Genetics: A strong genetic component is involved, with a significant association to the HLA-B27 gene. Those with a family history of AS are at a higher risk.
2. Family History: If a first-degree relative has AS, the likelihood of developing the condition increases by 5 to 16 times.

Symptoms:

• Persistent lower back pain and stiffness, especially in the morning or after periods of inactivity.
• Limited spinal flexibility and reduced posture.
• Pain and inflammation in other joints, particularly the hips and shoulders.
• Fatigue, due to the chronic inflammatory process.

Complications:
In severe cases, untreated AS can lead to:

• Fusion of the spinal bones, resulting in a rigid, immobile spine (often called bamboo spine).
• Eye inflammation (uveitis), causing pain, redness, and blurred vision.
• Cardiovascular complications, including inflammation of the heart valves.

Diagnosis:

• Medical History: Symptoms, age of onset, and family history.
• Imaging: X-rays, MRIs, or CT scans to detect spinal changes.
• Genetic Testing: Screening for the HLA-B27 marker, which is commonly associated with AS.

Management and Treatment:

1. Medications:
   • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and stiffness.
   • Biologics and disease-modifying antirheumatic drugs (DMARDs) to reduce inflammation.
2. Physical Therapy:
   • Exercises to maintain posture, flexibility, and spinal mobility.
   • Strength-building routines tailored to individual needs.
3. Lifestyle Modifications:
   • Regular low-impact activities like swimming or yoga.
   • Ergonomic adjustments for daily activities to reduce strain.
4. Advanced Treatments:
   • In severe cases, surgical interventions may be recommended.

Take Action Early
Ankylosing spondylitis can vary in severity from mild discomfort to significant disability. Early diagnosis and treatment can help manage symptoms, prevent complications, and improve quality of life.

What is Sciatica?
Sciatica is a condition caused by irritation or compression of the sciatic nerve, the largest nerve in the body. This leads to pain that typically affects one side of the body, radiating from the lower back down to the leg. It can also cause numbness and difficulty controlling the leg, significantly impacting daily activities.

Anatomy of the Sciatic Nerve
The sciatic nerve originates in the lower spine, specifically from the L5 and S1 nerve roots, and travels through the pelvis, buttock, and down the back of the thigh. At the knee, it divides into smaller nerves that extend into the calf and foot. Its extensive range explains the widespread pain and discomfort associated with sciatica.

Causes of Sciatica
The primary cause of sciatica is compression or irritation of the sciatic nerve, often due to:

• Herniated Discs: Discs in the lumbar or sacral regions can bulge or rupture, pressing on the nerve.
• Spinal Stenosis: Narrowing of the spinal canal can lead to nerve compression.
• Piriformis Syndrome: The piriformis muscle in the buttock can irritate the sciatic nerve.
• Trauma or Injury: Direct injury to the lower back or pelvis.

Signs and Symptoms of Sciatica
Sciatica symptoms can range from mild to severe and may include:

1. Pain:

   • Radiates from the lower back to the buttock, thigh, calf, or foot.
   • Can be sharp, burning, or shooting.

2. Numbness or Tingling:

   • Affected areas may feel numb or experience a pins-and-needles sensation.

3. Muscle Weakness:

   • Trouble controlling the affected leg or foot.

4. Severe Symptoms:

   • Loss of bladder or bowel control.
   • Progressive weakness or numbness.

Note: Severe symptoms require immediate medical attention, as they could indicate serious nerve damage.

Impact on Daily Life
For many, sciatica pain can impair basic functions, making activities like walking, sitting, or bending difficult. It’s essential to seek treatment early to prevent worsening symptoms.

Treatment Options for Sciatica

1. Conservative Management:

   • Rest and physical therapy.
   • Medications such as anti-inflammatory drugs or muscle relaxants.
   • Hot and cold compresses for pain relief.

2. Advanced Therapies:

   • Epidural steroid injections to reduce inflammation.
   • Surgery in severe cases, such as discectomy or laminectomy, to relieve nerve compression.

3. Lifestyle Changes:

   • Regular exercise to strengthen core and back muscles.
   • Ergonomic adjustments to reduce strain on the spine.

Don’t Ignore Sciatica
While mild cases may resolve on their own, untreated or severe sciatica can lead to chronic pain and complications. Early diagnosis and appropriate treatment can improve quality of life.

What is Scoliosis?
Scoliosis is a medical condition characterized by an abnormal side-to-side curvature of the spine, which can appear as an “S” or “C” shape when viewed from the back. While mild curvatures are common and may not require treatment, curves exceeding 30 degrees need close monitoring as they can worsen rapidly. Scoliosis is more prevalent in individuals with osteoarthritis compared to the general population.

Anatomy of Scoliosis
In a normal spine, the curvature is primarily front-to-back, and the spine appears straight when viewed from the back. In scoliosis, the spine deviates laterally, often accompanied by the rotation of individual vertebrae.

• Mild Curvature: 10–20 degrees.
• Moderate Curvature: 20–50 degrees.
• Severe Curvature: Greater than 50 degrees.

Causes of Scoliosis
Approximately 80–85% of scoliosis cases are idiopathic, meaning their cause is unknown. However, scoliosis can be classified based on its origin:

1. Functional Scoliosis:
   The spine is structurally normal but appears curved due to external factors such as:

   • Leg length discrepancies.
   • Muscle spasms.
   • Inflammatory conditions like appendicitis.

2. Structural Scoliosis:
   Involves an abnormal curvature of the spine caused by:

   • Birth defects.
   • Spinal injuries or infections.
   • Tumors.
   • Neuromuscular diseases (e.g., polio, muscular dystrophy, cerebral palsy).
   • Connective tissue disorders.

Symptoms of Scoliosis
Scoliosis is often painless, making it challenging to detect early. Routine physical exams frequently lead to its diagnosis. Symptoms to watch for include:

• Uneven shoulders or hips.
• A tilted head that does not align over the hips.
• Protruding shoulder blades.
• Unequal breast size in developing girls.
• An uneven hemline or neckline.
• Noticeable curvature or unevenness when the individual bends forward.

Diagnosis of Scoliosis
Diagnosing scoliosis involves a thorough medical history, physical examination, and imaging tests:

• Physical Exam: Observing posture, spinal alignment, and symmetry.
• X-rays: To determine the degree of curvature using the Cobb angle.
• MRI: Occasionally used to assess underlying conditions or complications.

Treatment of Scoliosis

1. Non-Surgical Treatment:

   • Regular monitoring with physical exams and X-rays.
   • Bracing for cases with ongoing spinal growth to prevent further curvature.
   • Physical therapy, though not proven effective for curve correction, may help with posture and strength.

2. Surgical Treatment:

   • Spinal Fusion:
     • Involves straightening the spine using stainless steel rods and hooks.
     • A bone graft is added to fuse the spine in the corrected position.
     • Over time, the fused segment solidifies, preventing future curvature.
   • The unfused segments of the spine remain flexible, allowing normal movement.

Early Detection Matters
Scoliosis can progress over time if left untreated, leading to significant deformity and potential complications. Early diagnosis and appropriate treatment are key to preventing severe curvature and maintaining quality of life.